BOARD OF SUPERVISORS

COUNTY OF SAN DIEGO BOARD OF SUPERVISORS REGULAR MEETING MEETING AGENDA TUESDAY, OCTOBER 27, 2026, 9:00 AM COUNTY ADMINISTRATION CENTER BOARD CHAMBER, ROOM 327 1600 PACIFIC HIGHWAY SAN DIEGO, CA 92101 County of San Diego Board of Supervisors Tuesday, October 27, 2026, 9:00 a.m. A. Roll Call Call to Order the General Legislative and Land Use Legislative Regular Meeting. B. Opening Ceremonial Matters 1) Invocation 2) Pledge of Allegiance 3) Presentation or Announcement of Proclamations and Awards C. Non-Agenda Public Comment Individuals can address the Board on topics within its jurisdiction that are not on the open session agenda, including items that may be considered in Closed Session. Pursuant to the Board of Supervisors’ Rules of Procedure, Rule 4(a)(8), the first ten (10) speakers will be heard at the beginning of the meeting (five individuals in person, five individuals by phone). The remaining speakers will be heard at the conclusion of the General Legislative Session. D. Approval of Statements of Proceedings/Minutes Approval of the Statement of Proceedings/Minutes for the sessions of October 6, 2026 and October 7, 2026. E. Consent Agenda All agenda items listed under this section are considered to be routine and will be acted upon with one motion. There will be no separate discussion of these items unless a member of the Board of Supervisors or the Chief Administrative Officer so requests, in which event, the item will be considered separately in its normal sequence. Tuesday, October 27, 2026 1

1. Sheriff - Receive Donation from ADT Inc. for Computer-Aided Dispatch Enhancement (Districts: All) Recommendation by Sheriff: 1) In accordance with County of San Diego Administrative Code Article III, Section 66, Acceptance of Gifts, and Board of Supervisors Policy A-112, Acceptance and Use of Gifts and Donations, accept a donation of computer-aided dispatch enhancement software installation and integration valued at $41,080 from ADT to the San Diego Sheriff’s Office. 2) Authorize the Chair of the Board of Supervisors to sign a letter of appreciation on behalf of the Board of Supervisors and the County of San Diego to ADT. Board Letter Agenda Information Sheet Approval Log Attachment A - Letter of Appreciation Attachments: 2. Sheriff - Authorize a Competitive Solicitation for an Automated Biometric Identification System and Establish Appropriations (Districts: All) Recommendation by Sheriff: 1) In accordance with Section 401, Article XXIII of the County Administrative Code authorize the Director of the Department of Purchasing and Contracting to issue a competitive solicitation for an Automated Biometric Identification System, and upon successful negotiations and determination of a fair and reasonable price, award a contract for an initial term of five years, with five one-year option periods, and an additional six-month extension, if needed, and to amend the contract as needed to reflect changes to service requirements and funding, subject to approval of the Sheriff. 2) Establish appropriations of $5,000,000, in the San Diego Sheriff’s Office, Capital Assets Equipment, for the purchase and implementation of an Automated Biometric Identification System, based on prior year available Sheriff Fingerprint ID Trust Fund fund balance. (4 VOTES) Board Letter Agenda Information Sheet Approval Log Attachments: 3. Sheriff - Addition of One School Resource Officer in the City of Vista (District: 5) Recommendation by Sheriff: 1) Approve and authorize the Sheriff’s Office to add one staff year to support the City of Vista Tuesday, October 27, 2026 2

and direct the Department of Human Resources to classify the position at the appropriate level. 2) Establish appropriations of $336,945 in the Sheriff’s Office, Salaries & Benefits ($181,595), Services & Supplies ($60,852), and Capital Assets Equipment ($94,498) for law enforcement services based on unanticipated revenue from the City of Vista. (4 VOTES) 3) Transfer appropriations of $94,498 from the Sheriff’s Office, Capital Assets Equipment, to the General Fund Contributions to Fleet Internal Service Fund (ISF), Operating Transfer Out, to purchase one vehicle. 4) Establish appropriations of $94,498 in the Department of General Services Fleet ISF, Capital Assets Equipment, for the purchase of one vehicle for the Sheriff’s Office based on an operating transfer from the General Fund. (4 VOTES) 5) Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires full cost recovery for fees, grants, and revenue contracts. Board Letter Agenda Information Sheet Approval Log Attachments: 4. Ratify Application and Accept Funding Related to California Department of Industrial Relations Workers’ Rights Enforcement Grant Program (Districts: All) Recommendation by Chief Administrative Officer: 1) Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full cost recovery for grants, as this grant program does not recover full cost. 2) Ratify the submission of the grant application to the California Department of Industrial Relations, Labor Commissioner’s Office, for the Workers’ Rights Enforcement Grant Program for the project period July 1, 2026, through June 30, 2027, and, provided there are no material changes to the grant terms and funding levels, authorize the Office of County Counsel to apply for future project period grants through July 31, 2030. 3) Authorize County Counsel, or designee, in this year and through July 31, 2030, to execute all required grant and grant-related documents, including agreements and any annual extensions, amendments, and/or revisions thereof that do not materially impact or alter the services or funding levels. Board Letter Agenda Information Sheet Approval Log Attachments: Tuesday, October 27, 2026 3

5. Adopt Resolution to Sell Approximately 11.71 Acres on Cottonwood Avenue and Authorize Public Auction, Declare Approximately 12 Acres on Magnolia Avenue Surplus, Authorize Notice of Availability and Approve CEQA Exemption (District: 2) Recommendations by Chief Administrative Officer: 1) Find the proposed sale of County Parcel Number 2013-0091-A and declaration of County Parcel No. 2023-0036 C - D as surplus are categorically exempt from the California Environmental Quality Act (CEQA) pursuant to State CEQA Guidelines Section 15312. 2) Find the proposed actions of adopting a resolution, advertising County’s Notice of Adoption, conducting a bid opening, and selecting highest responsible bidder for County Parcel Number 2013-0091-A and issuance of a Notice of Availability for County Parcel No. 2023- 0036 C - D are not subject to review under the California Environmental Quality Act (CEQA) pursuant to State CEQA Guidelines section 15060(c)(3) because the actions are administrative and will not result in direct or indirect physical changes in the environmental effect on the environment, and are, therefore, not a project subject to CEQA as defined in section 15378. 3) Approve and adopt the Resolution entitled: RESOLUTION OF INTENTION TO SELL REAL PROPERTY AND NOTICE INVITING BIDS FOR REAL PROPERTY NUMBER 2013-0091-A. (4 VOTES) 4) Direct the Clerk of the Board of Supervisors to post the adopted Resolution and advertise the County’s Notice of the Adoption of the Resolution of Intention to Sell Real Property Number 2013-0091-A in accordance with the Government Code Sections 25528 and 6063. 5) Authorize the Director, Department of General Services, or designee, to conduct the bid opening and select the highest responsible bidder for Real Property Number 2013-0091-A, on January 22, 2027, and return to the Board for the final approval of the highest bidder. 6) Declare the approximately 12-acre portion of the Remainder Parcel, County Parcel No. 2023 -0036 C - D, surplus and not necessary for County’s use. 7) Authorize the Director, Department of General Services, or designee, to issue a Notice of Availability for the approximately 12-acre Remainder Parcel, County Parcel No. 2023-0036 C - D, pursuant to the requirements of the Surplus Land Act. Board Letter Agenda Information Sheet Approval Log Attachment A - Property 1 Location Map Attachment B - Remainder Parcel Location Map Attachment C - Notices of Exemption Attachment D - Resolution Attachment E - Bid Package Attachment F - Notice of Adoption of Resolution Attachments: Tuesday, October 27, 2026 4

6. General Services - Approve License Agreement for the San Diego Sheriff’s Office Detentions Communications System, and CEQA Notice of Exemption (District: 2) Recommendations by Chief Administrative Officer: 1) Find the proposed action to license space at the existing South Bay Regional Center (SBRC) exempt from the California Environmental Quality Act (CEQA) pursuant to CEQA Guidelines Section 15301. 2) Approve and authorize the Director, Department of General Services, or designee, to execute the proposed license with the Judicial Council of California at SBRC. Board Letter Agenda Information Sheet Approval Log Attachment A - Notice of Exemption Attachments: 7. General Services - Authorize Change Order to Construction Manager at Risk Contract for the San Diego Central Jail Major Systems Renovation Project and Related CEQA Finding (District: 1) Recommendation by Chief Administrative Officer: 1) Find that the proposed added scope of work for the San Diego Central Jail Major Systems Renovation Project is exempt from the California Environmental Quality Act (CEQA) review pursuant to CEQA Guidelines Sections 15301 and 15302 2) Find that competitive procurement of the additional work for the San Diego Central Jail Major Systems Renovation Project would be unavailing, impractical, and would not produce any public advantage 3) Waive Board Policy A-87, Competitive Procurement, for the additional work to be performed at the San Diego Central Jail 4) Authorize the Director, Department of Purchasing and Contracting, to execute a change order or change orders not to exceed the aggregate amount of $10,858,000 to Contract No. 575225 with Balfour Beatty Construction for refurbishing kitchen coolers, kitchen dishwasher and countertop replacements, duct cleaning, air handler unit replacements, plumbing fixture replacements, bathroom renovations, and other work (4 VOTES) Board Letter Agenda Information Sheet Approval Log Attachment A - Notice of Exemption Attachments: 8. General Services - Approve New Lease for San Diego County District Attorney and CEQA Notice of Exemption (District: 1) Tuesday, October 27, 2026 5

Recommendations by Chief Administrative Officer: 1) Find the proposed lease for San Diego County District Attorney at 550 West C Street, San Diego, is exempt from the California Environmental Quality Act (CEQA) pursuant to State CEQA Guidelines Sections 15301 and 15311. 2) Approve and authorize the Director, Department of General Services, or designee, to execute the lease with 550 Corporate Owner LLC for office space located at 550 West C Street, San Diego. Board Letter Agenda Information Sheet Approval Log Attachment A - Notice of Exemption Attachments: 9. Revised Rules Governing Incompatible Activities for the Department of General Services (Districts: All) Recommendation by Chief Administrative Officer: 1) Approve the revised Incompatible Activities Rules submitted by the Department of General Services. Board Letter Agenda Information Sheet Approval Log Attachment A - Statement of Incompatible Activities Attachments: 10. Approve 22 Conflict of Interest Codes Submitted by County Departments and Local Agencies for the Required Biennial Review (Districts: All) Recommendation(s) by Chief Administrative Officer: 1) Approve the amended Conflict of Interest Codes adopted by the following County departments (Attachment A): o County Counsel o Health and Human Services Agency o Parks and Recreation o Sheriff o Treasurer-Tax Collector 2) Approve the amended Conflict of Interest Codes adopted by the following agencies (Attachment B): o Alpine Fire Protection District o Bonsall Unified School District o Cabrillo Point Academy Tuesday, October 27, 2026 6

o Cajon Valley Unified School District o Del Mar Unified School District o Fallbrook Regional Health District o Grossmont-Cuyamaca Community College District o Grossmont Healthcare District o North County Fire Protection District o Otay Water District o Ramona Municipal Water District o San Diego Unified School District o San Diego Virtual School (prior code is being replaced in its entirety) o San Pasqual Union School District o Santa Fe Irrigation District o Santee School District o Vallecitos Water District Board Letter Agenda Information Sheet Approval Log Attachment A - Conflict of Interest Codes (County Departments)- Clean Copy Attachment B - Conflict of Interest Codes (Local Agencies)- Clean Copy Attachment C - Supporting Documents (County Departments) Attachment D - Supporting Documents (Local Agencies) Attachments: 11. Authorization to Execute Grant Agreement with the San Diego African American Museum of Fine Art for the San Diego Black Arts and Culture District and Related CEQA Exemption; District: All Recommendation by Chief Administrative Officer: 1) Find that the authorization to execute this grant agreement is not subject to review under the California Environmental Quality Act (CEQA) pursuant to CEQA Guidelines sections 15060(c)(2) and (3), 15061(b)(3), and 15378(b)(4) & (5) because the action is an administrative action intended to facilitate state and federal funding, does not commit the County to a specific project, and will not have a reasonably foreseeable direct or indirect effect on the environment. 2) Authorize the Chief Administrative Officer or designee to execute a grant agreement with the San Diego African American Museum of Fine Art utilizing the $500,000 allocated by the Board on May 5, 2026 (14) for the benefit of the San Diego Black Arts and Culture District and any subsequent amendments that do not materially change the terms. Board Letter Agenda Information Sheet Approval Log Attachments: Tuesday, October 27, 2026 7

12. Acceptance Of Gifts and Donations Exceeding $5,000 to the San Diego County Library and Related CEQA Exemption (Districts: All) Recommendation by Chief Administrative Officer: 1) Find that the proposed action is not subject to review under the California Environmental Quality Act (CEQA) pursuant to CEQA Guidelines Section 15060(c)(3) because it is not a project as defined in Section 15378(b)(5) of the CEQA Guidelines because it involves organizational or administrative governmental activities that will not result in direct or indirect physical changes in the environment. 2) In accordance with County of San Diego (County) Administrative Code Section 66, Acceptance of Gifts, and Board of Supervisors (Board) Policy A-112, Acceptance and Use of Gifts and Donations, accept the San Diego County Library Report of Gifts and Donations for the period of January 1, 2026, through June 30, 2026. 3) In accordance with County Administrative Code Section 66 and Board Policy A-112, ratify the acceptance of gifts from January 1, 2026, through June 30, 2026, for $121,218.79 that exceed $5,000. 4) Authorize the Chair of the Board of Supervisors to sign letters of appreciation on behalf of the County of San Diego to donors listed in Attachment B. Board Letter Agenda Information Sheet Approval Log Attachment A - Summary Report of Gifts Received Attachment B - Report of Gifts Received - Cash Attachment C - Report of Gifts Received - Non-Cash Attachment D - Letters of Appreciation Attachments: 13. Ratify Acceptance of Gifts and Donations Exceeding $5,000 to the Department of Environmental Health and Quality and Related CEQA Exemption (Districts: All) Recommendations by Chief Administrative Officer: 1) Find that the proposed action is not subject to review under the California Environmental Quality Act (CEQA) pursuant to State CEQA Guidelines section 15060(c)(3) because it will not result in a direct or reasonably foreseeable indirect physical change in the environment and the action is not a project as defined in Section 15378(b)(5) of the State CEQA Guidelines. 2) In accordance with Administrative Code, Section 66, Acceptance of Gifts, and Board Policy A-112, Acceptance and Use of Gifts and Donations, accept the County of San Diego Department of Environmental Health and Quality Report of Gifts and Donations from the California CUPA Forum Board for the period of January 1, 2026, to June 30, 2026. Tuesday, October 27, 2026 8

3) In accordance with Administrative Code Section 66 and Board Policy A-112, ratify the acceptance and expenditure of gifts from the California CUPA Forum for the period of January 1, 2026, to June 30, 2026, that exceeded $5,000. Board Letter Agenda Information Sheet Approval Log Attachment A - DEHQ Report Attachments: 14. Semi-Annual Report of Gifts and Donations and Ratification of Acceptance of Gifts and Donations Exceeding $5,000 to the Department of Parks and Recreation and Related CEQA Determination (Districts: All) Recommendation by Chief Administrative Officer: 1) Find that the proposed actions are not subject to the California Environmental Quality Act (CEQA) pursuant to State CEQA Guidelines Sections 15060(c)(3) and 15378(b)(5). 2) In accordance with County of San Diego (County) Administrative Code Section 66, Acceptance of Gifts, and Board of Supervisors (Board) Policy A-112, Acceptance and Use of Gifts and Donations, accept the County Department of Parks and Recreation Report of Gifts and Donations from January 1, 2026, to June 30, 2026 from the San Diego County Parks Society totaling $63,697.87 and the Valley Center Little League totaling $23,015.24. 3) In accordance with County Administrative Code Section 66 and Board Policy A-112, ratify the acceptance of gifts from the San Diego County Parks Society and the Valley Center Little League for the period of January 1, 2026, to June 30, 2026, that exceed $5,000. 4) Authorize the Chair of the County Board of Supervisors to sign letters of appreciation on behalf of the County of San Diego to the San Diego County Parks Society and the Valley Center Little League. Board Letter Agenda Information Sheet Approval Log Attachment A - Semi-Annual Report Attachment B - Letters of Appreciation Attachments: 15. Set a Hearing for November 17, 2026: Ashwood Street Corridor Improvement Project and Right-of-Way Acquisition - Request to Extend Hearing Date to Consider Adoption of a Resolution of Necessity and Related CEQA Findings (District: 2) Recommendation by Chief Administrative Officer: Tuesday, October 27, 2026 9

1) Find that the currently proposed action is not considered a project under CEQA Guidelines section §15378(b)(5). Today's action is limited to setting a new public hearing for November 17, 2026, at which time the Board of Supervisors will consider whether to adopt a Resolution of Necessity for acquisition of the subject parcels, and directing the Clerk of the Board to give the required notice. This action constitutes an organizational or administrative activity of government that does not approve, authorize, or commit the County to the acquisition of property, physical development, construction activities, or implementation of the underlying project, and therefore will not result in a direct or indirect physical change in the environment. 2) Set a new public hearing date for November 17, 2026, to consider adoption of a Resolution of Necessity for the Ashwood Street Corridor Improvement Project for the following parcels: 2016-0281-A,-B (CARV), and 2016-0285-A,-B1,-B2,-C1,-C2,-D1,-D2,-E (Nelson). 3) Direct the Clerk of the Board of Supervisors to send a "Notice of Hearing Regarding County of San Diego's Intention to Consider the Adoption of a Resolution of Necessity to Acquire Property By Eminent Domain" to each person whose name and address appears on the last equalized County assessment rolls for the following parcels 2016-0281-A, -B (CARV), 2016 -0285-A,-B1,-B2,-C1,-C2,-D1,-D2,-E (Nelson). Board Letter Agenda Information Sheet Approval Log Attachment A - Vicinity Map Attachment B - Property Map Attachments: 16. General Services - Adopt a Resolution to Summarily Vacate a Portion of an Irrevocable Offer of Dedication for Public Highway in the Alpine Community Plan Area and CEQA Finding (VAC 2025-0182) (District: 2) Recommendation by Chief Administrative Officer: 1) Find the proposed vacation of an IOD is exempt from the California Environmental Quality Act (CEQA) pursuant to State CEQA Guidelines Section 15303. 2) Adopt a Resolution entitled: RESOLUTION TO SUMMARILY VACATE A PORTION OF AN IRREVOCABLE OFFER OF DEDICATION FOR PUBLIC HIGHWAY IN THE ALPINE COMMUNITY PLAN AREA (VAC 2025-0182) (Attachment C, on file with the Clerk of the Board). 3) Direct the Clerk of the Board to record the Resolution for Vacation No. 2025-0182 pursuant to State of California Streets and Highways Code Section 8336. Tuesday, October 27, 2026 10

Board Letter Agenda Information Sheet Approval Log Attachment A- Location Map Attachment B- Vacation Exhibit Attachment C- Resolution Attachment D- Notice of Exemption Attachment E- Resolution Exhibits A & B Attachments: 17. Adopt a Memorandum of Agreement with the City of San Diego and Advertise and Award a Construction Contract for Saturn Boulevard Pipe Extension Project and Related CEQA Exemption (District: 1) Overview The Tijuana River Valley (TJRV) and surrounding South Bay communities have suffered severe and prolonged impacts from untreated sewage flows, urban runoff, and associated toxic airborne emissions. These conditions pose a significant threat to public health, environmental resources, and local economies, causing repeated beach closures and other hazards in nearby neighborhoods. In response, the County of San Diego (County) Board of Supervisors (Board) has taken multiple actions as part of an aggressive multi-agency strategy to address this environmental and public health crisis. On June 27, 2023 (16), the Board proclaimed a local emergency and has reaffirmed that declaration 26 times. On June 24, 2025 (10), the Board established the Ad Hoc Subcommittee on the Tijuana River Sewage Crisis (now the Standing Committee on the Tijuana River Pollution Crisis) to evaluate and advance urgent solutions, including infrastructure projects to mitigate “toxic hot spots” beginning with the Saturn Boulevard crossing area. Turbulent water flows at the Saturn Boulevard culvert crossing are known to release hydrogen sulfide gas and other pollutants into the air, causing health risks for residents in the surrounding community. A feasibility study prepared by Dudek in January 2026 identified both immediate and long-term infrastructure solutions to address this area. The near-term solution it identified is the Saturn Boulevard Pipe Extension Project. The proposed pipe extension system will attach high-density polyethylene (HDPE) pipe extensions to the outlet of selected existing drainage culverts at the Saturn Boulevard crossing, extending them below the water surface in the downstream pond. By discharging the flow beneath the water’s surface, this project will reduce turbulence and foaming of the contaminated Tijuana River flows, which will reduce aerosolization of hydrogen sulfide and other harmful compounds into the air near residential areas. The long-term, permanent solution identified by the feasibility study involves a box culvert/bridge. This project would remove the portion of the roadway with the pipe culverts, regrade the channel upstream and downstream to be a smoother transition, and install a box culvert to replace the pipe culverts. On January 28, 2026 (15), the Board received an update from the Ad Hoc Subcommittee which Tuesday, October 27, 2026 11

highlighted the Saturn Boulevard site as the highest-priority infrastructure hotspot in the County’s response to the sewage crisis. The Board directed the Chief Administrative Officer to include $2.5M for the capital costs to construct a near-term pipe extension at Saturn Boulevard; should alternative funding be identified, the $2.5 million will support immediate needs for the Tijuana River Valley. As the project is located within the City of San Diego and on Navy property, the Board also directed the Chief Administrative Officer, or designee, to begin working with the City of San Diego and the United States Navy on an agreement to move forward with the near-term infrastructure pipe extension project at Saturn Boulevard. The County worked with the City of San Diego to develop a Memorandum of Agreement, which specifies that the County serves as the lead agency for design, permitting, construction, coordination with the Navy, and five years of monitoring and oversight, while both Parties commit to accelerated schedules, shared decision-making, and a structured process for pivoting to a permanent solution if funding becomes available. The agreement establishes roles, timelines, environmental compliance requirements, fiscal responsibilities, indemnification, communication protocols, and termination provisions to ensure coordinated action. The Agreement is included as Attachment B and has been signed by both parties. The County has also obtained letters of support from the Navy, included as Attachment C, and completed project design, necessary technical studies, and secured required regulatory permits in coordination with the City of San Diego, U.S. Navy, and California Coastal Commission. On September 1, 2026 (14), the Board took additional action and authorized the allocation of $4.0M within the Unlocked Reserves Framework for the design of the permanent Box Culvert/Bridge solution at Saturn Boulevard to begin work on the permanent solution while the immediate solution moves forward. While the design is underway for this project, today’s action advances the construction of the pipe extension project. The pipe extension addresses an immediate public health problem, while the County works to secure a much larger investment for the permanent solution. If funding for the permanent solution becomes available soon, the County will be positioned to pivot from construction of the near-term solution to the permanent solution. If it does not, the near-term project can still provide needed relief while that funding is pursued. Both of these pathways are addressed in the agreement with the City, which is being considered for adoption today Today’s requested actions will provide the authority needed to adopt the Memorandum of Agreement with the City of San Diego to Address Infrastructure Upgrades at Saturn Boulevard and begin construction of the Saturn Boulevard Pipe Extension Project. This includes authorizing the Director of the Department of Purchasing and Contracting to advertise and award a construction contract to the lowest responsive and responsible bidder, consistent with County Administrative Code Section 401, without further Board action, and in accordance with Board policy. In addition, it is recommended that the Board adopt a finding that the project is exempt from environmental review under the California Environmental Quality Act (CEQA) pursuant to CEQA Guidelines (Cal. Code of Regs., tit. 14, § 15000 et seq.), Sections 15269(b) and 15269(c). Construction of the pipe extension is expected to commence in early 2027 and be completed by summer 2027, providing near-term relief from health hazards for the impacted communities while more permanent long-term solutions are developed and funded. Note that the construction timeline may be impacted by the anticipated El Niño in the upcoming rainy season. Tuesday, October 27, 2026 12

Board Letter Agenda Information Sheet Approval Log Attachment A - Vicinity Map Attachment B - Memorandum of Agreement Attachment C - Navy Letters of Support Attachments: 18. Communications Received (Districts: All) Recommendation by Chief Administrative Officer: 1) Note and file. Board Letter Agenda Information Sheet Approval Log Attachment A - CR List Attachment B - CR1. Contracts and Agreements Attachment C - CR2. County Staff Information Reports Attachment D - CR3. Meeting Minutes Attachment E - CR4. Other Government Entities- Official Notifications Attachment F - CR5. Planning and Development Services Attachment G - CR6. Public Communication Attachment H - CR7. Recorded Documents Attachments: Special Districts Consent Agenda When the Board of Supervisors meets as the governing body of a special district, they are acting in a different capacity than during their regular County business. In this role, the Board makes decisions that apply only to that specific district, such as approving its budgets, projects, policies, and operations. These actions are legally separate from the Board’s actions as the County of San Diego, and they apply only to the area and responsibilities of the special district. None F. Discussion Items These items are presented for Board consideration and public discussion. Discussion Items may involve staff presentations and deliberation by the Board. The Board may provide direction, adopt recommendations, or take other appropriate actions. Please note that the Board may take items in a different order than they appear on the agenda. Tuesday, October 27, 2026 13

19. Noticed Public Hearing: Receive Public Input on Housing and Community Development Needs and Approve the Fiscal Year 2027-28 Annual Plan Strategy [Noticed Public Hearing - Community Input for Fiscal Year 2027-28 Annual Plan Strategy for the Community Development Block Grant, Home Investment Partnerships, Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS] (Districts: All) Recommendation by Chief Administrative Officer: 1) Hold this public hearing to receive public input on the housing and community development needs and the draft 2027-28 Annual Plan Strategy. 2) Approve the 2027-28 Annual Plan Strategy. Board Letter Agenda Information Sheet Approval Log Attachment A - 2027-28 Annual Plan Strategy Attachments: 20. Receive County Medical Services (CMS) Reform Analysis, Approve Recommendations on Reforms to CMS, Approve Amendments to Board Policy A-67, and Adopt an Ordinance Amending the San Diego County Administrative Code Relating to Liens for Health and Human Services Costs (10/27/2026 - First Reading; 11/17/2026 - Second Reading, unless the ordinance is modified on second reading) (Districts: All) Recommendation by Chief Administrative Officer: 1) Receive the County Medical Services (CMS) Reform Analysis. 2) Direct the Chief Administrative Officer (CAO) to proceed with implementation of the recommended reforms to the CMS program described below, and provide various updates on implementation to the Board via memorandum in Spring 2027 and annually beginning in Fall 2027 through December 2029: a) Authorize implementation of the recommended changes to the CMS program beginning December 2026 as follows: 1. Remove property liens and in-person appointment requirement; 2. Remove the credit check requirement; 3. Eliminate the reimbursement agreement requirement; 4. Simplify the CMS application process by reducing paperwork and administrative burden; 5. Align property limits for CMS eligibility with Medi-Cal limits; 6. Increase transparency and accessibility of the CMS application and enrollment process; 7. Enhance transparency of Administrative Service Organization (ASO) oversight; 8. Increase application assistance by expanding the Hospital Outstation Point of Entry (HOPE) Program to pilot community health clinics; 9. Align appeal timelines for CMS application denials with Medi-Cal timeframe; 10. Align appeal timelines for CMS service denials with Medi-Cal Tuesday, October 27, 2026 14

timeframe; 11. Clarify the Emergency Department follow up Policy & Procedure. b) Return to the Board with recommended action plans for implementation on the following CMS reforms subject to more robust analysis and evaluation of program enrollment trends with the initial set of reforms described in Recommendation 2a, and subject to available funding: 1. Include Emergency Department follow-up care as a covered CMS benefit without prior authorization; 2. Remove the requirement to have a Medi-Cal denial in hospitals 3. Simplify the Share of Cost; 4. Remove the requirement of prior authorization for labs and diagnostics; 5. Simplify the CMS application process by aligning with the Medi-Cal application; 6. Extend the initial certification time period. 3) Approve amendments to Board Policy A-67 - Indigent Care and extend the sunset review date to December 31, 2033. 4) Direct the Chief Administrative Officer to continue to evaluate the following significant expansions to eligibility and coverage and report back to the Board of Supervisors in Spring 2027 with updates, and at least once annually thereafter through December 2029, and if substantial funding is identified, return to the Board of Supervisors with recommended action plans for implementation subject to further evaluation and overall funding availability: 1. Include Medi-Cal eligible individuals who do not meet Medi-Cal work requirements (19-64-year-olds); 2. Expand age criteria to include 19-20-year-olds; 3. Expand CMS eligibility to residents affected by Federal Immigration-Based Medi-Cal eligibility restrictions; 4. Include Medi-Cal eligible individuals who are terminated for procedural non-compliance; 5. Align CMS retroactive coverage timeline with Medi-Cal; 6. Expand dental services; 7. Include mild to moderate mental health services; 8. Include pregnancy and family planning services; 9. Include transplant services; 10. Include preventive care. 5) Approve the introduction of the Ordinance (first reading): AN ORDINANCE AMENDING THE SAN DIEGO COUNTY ADMINISTRATIVE CODE RELATING TO LIENS FOR HEALTH AND HUMAN SERVICES COSTS If on October 27, 2026, the Board takes action as recommended in item 5 above, then, on November 17, 2026: 6) Consider and adopt the ordinance (second reading): AN ORDINANCE AMENDING THE SAN DIEGO COUNTY ADMINISTRATIVE Tuesday, October 27, 2026 15

CODE RELATING TO LIENS FOR HEALTH AND HUMAN SERVICES COSTS7) ..End Equity Impact Statement Medi-Cal beneficiaries are predominantly low-income, with a maximum income of $22,000 per year for a single-person household to qualify for coverage in most circumstances. In San Diego County, 44% of the Medi-Cal population are Hispanic, 53% are between the ages of 19-64, and approximately one-third primarily speak a language other than English. Beginning January 1, 2027, federal changes under House Resolution 1 (H.R. 1) will impact individuals enrolled in Medi-Cal by adding work and community engagement requirements. These requirements apply to individuals ages 19 through 64 enrolled in, or applying for, Medi-Cal, and are identified as able-bodied adults without dependents. An estimated 68,761 San Diego County residents may lose Medi-Cal coverage due to these new requirements. Additionally, approximately 17,141 noncitizens currently receiving federally funded full-scope Medi-Cal may lose comprehensive coverage. H.R. 1 is expected to place additional demands on and impact the fiscal stability of San Diego County’s safety net. The actions recommended today represent an important step toward addressing these challenges by identifying opportunities for the County of San Diego’s indigent care program to be streamlined, more accessible, and more transparent. Recommendations also include continuing to identify solutions that address the increase in the number of uninsured individuals in San Diego County to ensure equitable access to care for the indigent population. Sustainability Impact Statement Today’s proposed action supports the County of San Diego (County) Sustainability Goal #1 to engage the community in meaningful ways; Sustainability Goal #2 to provide just and equitable access to County services; and Sustainability Goal #4 to protect the health and well-being of everyone in the region. Specifically, the CMS program acts as a safety net, providing access to emergency care for certain low-income adults who are not eligible for other health coverage programs and have no other means of support. Fiscal Impact Statement Funds for today’s request are included in the Fiscal Year (FY) 2026-28 Operational Plan in Health and Human Services Agency. If approved, this request is estimated to result in costs of $179,990 in FY 2026-27 and $308,600 in FY 2027-28. The breakdown of estimated fiscal impact of recommended changes to CMS is outlined in Attachment A. The fiscal impact noted will be absorbed by existing County staff currently budgeted and projected savings in the existing Tobacco Settlement Funds allocation. The available funding source is existing Tobacco Settlement Funds appropriations. There will be future fiscal impacts associated with further implementation of CMS reforms referenced in this board action. Staff will return to the Board for consideration and approval of any other future fiscal impacts that may result from the recommendations. Upon return by staff, funding will need to be incorporated into mid-year action or future operational plans based on available funding. There is no change in net General Fund cost and no additional staff years. Tuesday, October 27, 2026 16

Business Impact Statement N/A Advisory Board Statement This item was presented as a discussion item for the Social Services Advisory Board on July 8, 2026, the Health Services Advisory Board on July 21, 2026, the Behavioral Health Advisory Board on September 3, 2026, and the Healthy San Diego Consumer and Professional Advisory Committee on July 9, 2026, and September 24, 2026, to provide opportunities for input. This item was presented as an informational item to the Behavioral Health Advisory Board on October 1, 2026, and to the Health Services Advisory Board on October 13, 2026, with representatives in attendance from the Social Services Advisory Board and the Healthy San Diego Consumer and Professional Advisory Board. Background On March 3, 2026 (17), the San Diego County Board of Supervisors (Board) approved a comprehensive review of County Medical Services (CMS). This initiative was brought forward by the Social Safety Net and Behavioral Health Systems Transformation Ad Hoc Subcommittee (Subcommittee) to recommend reforms in anticipation of federal and State healthcare coverage changes. As part of this action on March 3, 2026 (17), the Board directed staff to analyze the feasibility, fiscal implications, and equity impacts of targeted reforms to CMS and make recommendations, including but not limited to: revisions to CMS eligibility; modernization of enrollment processes; eliminating the CMS lien requirements and reforming existing property limits; expanding phone and virtual application options; reviewing covered services, including how medical need is defined and evaluated, Emergency Department follow-up visits, pharmacy access, lab work, and diagnostic testing; analysis of how cost-sharing protocols impact patients’ ability to access services; review the branding and renaming of CMS to be reflective of potential revisions to eligibility standards; and evaluating fiscal impacts associated with any proposed changes. Stakeholder Engagement As part of the Board direction, the Health and Human Services Agency (HHSA) engaged collaboratively with organizations representing hospitals in the region, with primary emphasis on acute care hospitals, for the purpose of obtaining input related to the evaluation and development of the recommendations outlined in coordination with the Subcommittee. To gather input on potential changes to the current CMS program from stakeholders, five virtual listening sessions were held with participants representing hospitals, community health centers, community-based organizations, consumers, advocates, and health care partners. In addition to the listening sessions, the County received written input, convened one-on-one meetings with partners and provided regular updates to the following advisory bodies: · Health Services Advisory Board · Healthy San Diego Consumer and Professional Advisory Committee · Social Services Advisory Board · Behavioral Health Advisory Board Key themes identified through the listening sessions were shared with the Advisory Boards, whose feedback informed the recommendations to reform CMS presented in today’s item. While stakeholders expressed interest in expanding the scope of services available to CMS recipients, Tuesday, October 27, 2026 17

they emphasized that streamlining the application process and expanding eligibility should be the primary priorities. Additional information regarding stakeholder engagement and feedback is detailed in CMS Reform Analysis (Attachment A). Summary of CMS Reform Analysis The County analyzed the current CMS program and examined options to update CMS eligibility, enrollment, covered services, and delivery model. Guided by stakeholder input, the analysis explored potential reforms, including but not limited to the directed items. Additional details are outlined in Attachment A. The comprehensive CMS analysis evaluates costs, trade-offs, and community impacts across program eligibility, covered services, and administrative processes. Insights from internal reviews and stakeholder feedback revealed consistent themes that informed the development of proposed program modifications. After careful consideration of the assessed options for reform, the following recommendations were developed in consultation with the Subcommittee and informed by stakeholder input. The reforms are categorized as follows: · Recommended CMS Reforms: If approved by the Board, County staff will begin preparations to implement reforms described in Recommendation 2a.1-11 in December 2026. These reforms are intended to increase program participation by streamlining processes and removing barriers to enrollment. Additional proposed reforms will require further analysis and evaluation to determine appropriate next steps. · Future CMS reforms dependent on funding opportunities: These reforms include significant expansions to program eligibility and coverage for consideration pending identification of substantial new funding. Proceed with Implementation of the Recommendation 2 Reforms to the CMS program The proposed CMS reforms outlined below focus on streamlining administrative and eligibility processes. The recommended reforms under Recommendation 2a include: 1. Remove property liens and in-person appointment requirement: Eliminate the property lien requirement from the CMS application process and take steps to revoke existing liens recorded related to CMS provision or enrollment, eliminating the requirement for applicants to repay the cost of services through property liens. This reform will also eliminate the requirement for in-person application appointments. Implementation of this reform will necessitate an amendment to San Diego County Administrative Code Section 238 to remove the authorization for the Health and Human Services Deputy Chief Administrative Officer (DCAO) or designated representative, and the Director of the Office of Revenue and Recovery to secure payment by requiring execution and filing of liens consistent with Welfare and Institutions Code (WIC) 17109. In addition, the amendment will direct the DCAO and Director of Revenue and Recovery to immediately cease all collection activities and take measures to revoke any existing lien recorded under the CMS program prior to the effective date of this ordinance. Attachment D and E include the strikeout and clean versions of the Ordinance. 2. Remove the credit check authorization requirement: Eliminate the credit check authorization form and discontinue credit checks as part of the CMS application process. Tuesday, October 27, 2026 18

3. Eliminate the reimbursement agreement requirement: Remove the Reimbursement Agreement form and revise the reimbursement requirements elsewhere within the application. Recommendations 2.a.1-3 will be implemented December 2026. 4. Simplify the CMS application process by reducing paperwork: Reduce the documentation required to apply for CMS by eliminating forms related to property liens, credit checks, and reimbursement agreements. Eliminating in-person application appointment requirements to reduce the burden on applicants. Verbal signatures will continue to be accepted by phone and the possibility of enhancing the process by including online signatures will continue to be explored. Additional process improvements under consideration, including automatically initiating a CMS application following a Medi-Cal denial, may further simplify enrollment. Recommendation 2.a.4 will be implemented between December 2026 and June 2027. 5. Align property limits for CMS eligibility with Medi-Cal: Align CMS property eligibility limits with Medi-Cal requirements to simplify the application process and reduce duplicative documentation. This alignment may also facilitate the use of information applicants have already provided through the Medi-Cal application process. Recommendation 2.a.5 will be implemented between July and December 2027. 6. Increase transparency and accessibility of the CMS application and enrollment process: Modernize how CMS information is presented and shared to assist the public and providers in accessing CMS. Planned improvements include updating the CMS Patient Handbook and CMS Provider Handbook, redesigning the website, and utilizing QR codes and other tools to improve access to program information. 7. Enhance Administrative Service Organization (ASO) oversight: Reinforce oversight of the ASO in the areas of audits, clinical oversight, quality assurance and utilization management and publish updated policies on County CMS website. Additionally, quarterly program reporting will be established to support these efforts. 8. Increase Medi-Cal and CMS application assistance: Expand the Hospital Outstation Point of Entry (HOPE) Program to additional community health clinics as a pilot to increase dedicated County eligibility support for applicants and community-based application assisters in these critical locations. Staff will report back to the Board in Spring 2027 with results of the pilot and will return if resources are needed for expansion to additional sites. Recommendations 2.a.6-8 will be implemented between December 2026 and December 2027. Updates may continue through 2028 as needed to reflect any future changes to the CMS program. 9. Align appeal timeline for CMS application denials with Medi-Cal: Align appeal timelines for CMS application denials with those for Medi-Cal. The proposed reform also includes Tuesday, October 27, 2026 19

coverage of service costs during the appeal process, consistent with the applicable Medi-Cal process, to simplify program participation 10. Align appeal timeline for CMS service denials with Medi-Cal: Align appeal timelines for CMS service denials with those for Medi-Cal to promote consistency and simplify participation in the CMS program. 11. Clarify Emergency Department follow up Policy & Procedure: Stakeholders requested that Emergency Department follow-up care be covered by CMS without prior authorization. This fully requested reform is listed in the next section as an item to monitor and evaluate further in 2027-2028. However, the initial analysis identified the following two actions that can be taken in 2027 to address voiced concerns: a. Revise CMS policy and procedure documents to remove language that Emergency Department follow-up care is "never covered", and b. Amend CMS contracts with Federally Qualified Health Centers to ensure capacity for timely Emergency Department follow-up visits. Recommendations 2.a.9-11 will be implemented between July and December 2027. Building on the implementation of the initial CMS reforms outlined above, HHSA will further evaluate program enrollment trends and assess the impacts of these changes to inform recommendations for the next phase of CMS reforms. Staff will return to the Board with recommended action plans for the following reforms as described in Recommendation 2b, subject to the results of this evaluation and the availability of funding: 1. Include Emergency Department follow-up care as a covered CMS benefit without prior authorization: Monitor service denials and access to care for follow-up care at Emergency Departments between 2027-2028. 2. Remove the requirement to have a Medi-Cal denial in hospitals: Throughout 2027, develop case scenarios, monitor, and analyze data to identify trends and impact of the CMS policy. 3. Simplify the Share of Cost: In 2027, a proposal to modernize cost sharing by moving away from the Share of Cost model and towards a co-payment structure will be developed. This would replace the current model in which applicants with a household income falling between 0-165% of the Federal Poverty Level (FPL) may be eligible for CMS at no cost. Applicants with a household income falling between 165-350% FPL may be eligible for CMS Hardship program with or without a Share of Cost. 4. Stakeholders also suggested eliminating the Share of Cost for the CMS Hardship program altogether. This would result in zero share of cost for any CMS participants. Staff do not recommend moving forward with this reform at this time as additional information and analysis is needed. Instead, it is recommended to simplify the Share of Cost as described and monitor data to determine if additional reforms are needed. 5. Remove the requirement of prior authorization for labs and diagnostics: Currently, labs ordered as part of a referral to a specialist require prior authorization, which may delay care and add administrative burden. In 2027, research will be conducted on the health care industry standards and policies related to lab prior authorizations. Updates to the CMS policy will be considered in 2028. Tuesday, October 27, 2026 20

6. Simplify the CMS application process by aligning with the Medi-Cal application: In 2027 and 2028, continue working with the State to update their Medi-Cal application system to incorporate the CMS application. This would create a single system that streamlines moving from a Medi-Cal denial to initiating the CMS process. Additionally, it reduces the County staff administrative burden. A financial analysis and updated workflows for patients, providers, and County staff will be developed throughout 2028, and will be considered for implementation in 2029. 7. Extend the initial certification time period: Stakeholder feedback included extending the CMS initial certification from six months to one year. However, staff do not recommend moving forward with this reform in order to align with the Medi-Cal renewal timeline, which will be every six months beginning January 1, 2027. This allows for a process of ensuring the most vulnerable individuals at risk of losing Medi-Cal are assisted with reestablishing their coverage rather than relying on the payer of last resort. Expansions to eligibility and coverage pending identification of substantial funding: Analysis of the options listed below are for consideration pending identification of substantial new funding. 1. Include Medi-Cal eligible individuals who do not meet Medi-Cal work requirements (19- 64-year-olds): State and federal changes to Medi-Cal eligibility will begin January 1, 2027, which, over time as Medi-Cal renewals are due, will provide valuable data to the County to understand the full impact of these changes and identify how utilization of the CMS program may change. Throughout 2027, these trends will be monitored, and fiscal analyses will be conducted to provide a recommendation on changes to the CMS policy to be considered for implementation in 2028. 2. Expand age criteria to include 19-20-year-olds: Currently, CMS eligibility includes 21- 64-year-olds, however the H.R.1 work requirements for able bodied adults without dependents impacts 19-64-year-old Medi-Cal beneficiaries. The impact of this new requirement will be monitored and analyzed throughout 2027. 3. Expand CMS eligibility to residents affected by federal immigration-based Medi-Cal eligibility restrictions: Beginning July 2027, federal and state changes will impact access to full scope Medi-Cal for many individuals based on their immigration status. In 2028, a fiscal impact study will be conducted to inform the development of a recommendation related to expanding the list of immigration statuses. 4. Include Medi-Cal eligible individuals who are terminated for procedural non-compliance: It is expected that new, additional documentation requirements for applying for, or renewing, Medi-Cal will create barriers to successfully applying for coverage. This will result in eligible individuals having their coverage terminated. Additionally, individuals who are not impacted by H.R. 1 but may still have challenges with providing the necessary Medi-Cal application documentation. This impact will be monitored and analyzed in 2028. 5. Align CMS retroactive coverage timeline with Medi-Cal: CMS retroactive coverage can be aligned with Medi-Cal to continue streamlining and simplifying the CMS program. To ensure this change can be implemented effectively, data will be collected and analyzed throughout 2028, with a final recommendation to be proposed in 2029. 6. Expand dental services: Stakeholder feedback included expanding services to include non-emergency and preventive dental care, with a focus on people with diabetes and heart disease. To understand the fiscal impact of adding this service, data will be Tuesday, October 27, 2026 21

gathered and analyzed in 2028 to provide a specific recommendation on what the CMS program would cover by the end of the year. 7. Include mild to moderate mental health services: Currently, CMS does not cover mental health services. Expanding service coverage to include mild to moderate mental health will fill a gap in access to care, as severe mental health services are covered by other programs. In 2028, the County will coordinate with community providers for their input on changes to the CMS policy and data will be analyzed to understand the financial impact of expanding coverage. A proposal for implementation will be provided in 2029. 8. Include pregnancy and family planning services: Stakeholder feedback included consideration of CMS coverage for pregnancy and family planning. In 2028, an analysis will take place to identify the specific services that may be covered and the fiscal impact to develop a recommendation to be considered in 2028. 9. Include transplant services: Stakeholder feedback included consideration of CMS coverage for transplants. In 2028, an analysis will take place to identify the specific services that may be covered and the fiscal impact to develop a recommendation to be considered in 2028. 10. Include preventive services: There was significant stakeholder interest in expanding CMS coverage to include preventive services, including cancer screenings and immunizations. Analysis of anticipated utilization rates and fiscal impact will take place in 2027. Adopt Revised Board Policy A-67 On May 10, 1977, the Board of Supervisors adopted Board Policy A-67 on Primary Care Services, which established a governing policy for the provision of primary care services to legal residents of San Diego County in accordance with Section 17000 of the Welfare and Institutions Code. Board Policy A-67 was last updated on November 19, 2019, and is set to sunset on December 31, 2026. Since the County must review its local policy for continuation or revision, this is an opportunity to consider options for how CMS can best address local medical needs in a changing local, State, and federal health care landscape. Attachment B includes a strikeout version of Board Policy A-67 reflecting the proposed revisions based on the recommended CMS reforms, and Attachment C provides the corresponding clean version incorporating the proposed updates. Proposed updates to the policy include: 1. Revise the subject of the policy from Primary Care Services to Indigent Care: Reflect the policy’s broader purpose of guiding the County’s approach to fulfilling its indigent care obligations under California WIC Section 17000 for indigent care and update references throughout the policy. 2. Remove outdated background information: Eliminate background language that no longer reflects the current CMS program. 3. Update the County vision statement: Revise the vision statement referenced in the policy to reflect the County’s current vision. 4. Add the following to HHSA responsibilities in administration of this policy: a. Align the CMS application processes, administrative procedures and timelines Tuesday, October 27, 2026 22

with Medi-Cal, where feasible and where alignment improves patient access. b. Align CMS program policies and procedures with health care industry standards, where feasible and where alignment improves patient access. c. Maintain CMS program eligibility requirements, policy, and procedures in the County Medical Services Program Guide and make this information available to the public. Today’s item requests the Board receive the CMS Reform Analysis; approve implementation of the initial recommended changes to the CMS program for 2027; adopt revised Board Policy A-67 on Indigent Care (formerly Primary Care Services) and amend the sunset date; and adopt an Ordinance amending the San Diego County Administrative Code relating to liens for Health and Human Services costs. Staff will report back to the Board in Spring 2027 with an update on implementation progress and any progress on monitoring and evaluation of additional CMS reforms for consideration. Recommendations for future CMS reforms will be brought forth to the Board for approval prior to implementation. In addition, staff will continue to work in close collaboration with the Subcommittee and stakeholders on implementation and continued reform of the CMS program. Linkage To the County of San Diego Strategic Plan This action supports the County of San Diego 2026-2031 Strategic Plan initiatives of Community and Equity by ensuring access for all to health and social services, providing services that enhance the community’s well-being, and ensuring the capability to respond to the needs of individuals in the community. Respectfully submitted, Board Letter Agenda Information Sheet Approval Log Attachment A - County Medical Services Reform Analysis Attachment B - Board Policy A-67 Strikeout Attachment C - Board Policy A-67 Clean Attachment D - Ordinance Amending Administrative Code Strikeout Attachment E - Ordinance Amending Administrative Code Clean Attachment F - Summary Attachments: 21. Authorize a Safety Net Bridge Pilot Program to Address Anticipated Gaps in Services for Residents Disenrolled from Benefit Programs (Districts: All) Recommendation by Chief Administrative Officer: 1) Authorize the Chief Administrative Officer (CAO), or designee, to implement a 12-month pilot to support the primary care medical services component of the Safety Net Bridge program to serve San Diego County residents 19-64 years-old, who meet Medi-Cal eligibility Tuesday, October 27, 2026 23

criteria but may temporarily have a gap in coverage due to new requirements not to exceed $20,425,000 to be allocated as follows: a. $12,400,000 to fund primary care medical services, access to same-day no-cost prescription medications, and linkages to social services, including agreements with primary care providers who serve Medi-Cal patients identified through the competitive procurement process; b. $750,000 to fund expansion of community health fair events to provide primary care me