Miami-Dade Board of County Commissioners

see the wiring. >>. >> not. >>. >> jesus. >>. >>chair: course from one of my school director please do the honors. >> good morning to everyone for being here, thank you to our lovely students that participated. I want you to know we had 250 students participate in this year's poster contest and we have 1 winners so we have a few that are not here so these young ladies representing you today are represented with beautiful art that represents recycling. Reduce, reuse and recycle and if you could see the artwork we have a rubric, we had about four judges and went through and you can see all the detail that is represented in the artwork that's here today so I don't want to belabor the time, I want to call their names and I want you all to know tomorrow is global recycling day. Can I get a little bit of excitement? It's global recycling day tomorrow so this is intentional we are doing this today right before global recycling day so if I call your name couple of you not represented here because you're still in traffic and I'm going to do my best. Annabelle. >> annabella barreto. >> aniah barrios from robert morgan senior high, not here but let's give her a hand clap. Do we have art quintet from herbert evans middle? Thank you, can you hold that artwork up? Avada lawler, somerset academy bait. It's mariella from arvida middle. Then jennifer gimenez from robert morgan senior. Carol pinot from doctors charter school of miami shores. Nice. Then we also have carolyn reyes from palm springs middle. Not here. Nahani lazano from south dade middle. Dorothy m wallace center. [Applause] She's not here but I do believe the principal is here for that school. Then we have mila acosta from barbara: senior. Let's see that beautiful ful work. We have samantha carlino from robert morgan senior. Scarlett kendrick from violet k center. And last della costa from kenwood k-8. Congratulations all our winners, thank you for helping everyone to recycle right. I want to make one more thing, tomorrow we will be launching scrap, and after that we actually have. There is a key the qr code so when you don't know what to recycle, you're guessing trying to identify what to recycle just scan it and it will tell you if it is recyclable or not, this will help us reduce contamination in our system and help us improve our waste system so thank you for all your participation because recycling is all our jobs, all our recyclable ability. So we have the code here and I think the code is on our where releasing a a video the mayor and I did nd I did together and we're going to do the main thing tomorrow, tomorrow is the major launch because tomorrow is recycling day. >>mayor cava: thank you to director daniels and roy our chief, this has been an amazing year. With 250 submissions and 1 winners and I am so in love with each of these. When I've been planning what I will do is create cards I can use for protocol gifts, for whatever showcase the creativity and dedication of our young people for saving our planet. This is what it's all about and we know that people try to recycle but it's sometimes confusing want to recycle and that's why we have our new scrap and launched something called recycle opd so these are a couple ways you can be sure to recycle right and reduce our contamination and reduce the space in our landfills and whatever else is to come. But we do produce an extraordinary amount of waste in miami-dade county, double the national average so it's critically important in these young people are showing they are ambassadors for making sure we do right with our waste and reduce it, reuse it and recycle, all of the above so congratulations to our leaders for showing your parents, your teachers, our community the way thank you to director daniel with this great contest. [Applause] >>chair: if we can take a picture we have more commissioners now, the directors shared with me the month of APRIL on earth day we will be featuring these talented young persons artwork at the westchester library for the entire month and yes, yes. And I don't know what day it is today want to say we are still women's month and if you look up here I see 100% of young women so very talented young women and I'm sure there's young boys out there that couldn't make it today but the ones that did our young women so congratulations, let's get together for a photo. How do we do this? >> you. >>chair: thank you all and once again thank you to the students that participated. >>mayor cava: I want to acknowledge this is a product done in conjunction with miami-dade public schools and we have two representatives from the department, where are they? There they go. There they are, want to say a big thank you to them for facilitating this, it is an annual event and were so grateful to you and for their teachers who have made it possible for them to do this great work, thank you so much. >>chair: thank you so much. That's it. All right mayor, you could look at it at the westchester library if you wanted to see each one individually. Where's jasmine? Where's my staff? All right guys. You can take a seat. I think there's a little too much green beer. All right. We have two more presentations. Commissioner, saint patty's day. Happy st. Patrick's day to everybody this morning. We have our sheriff joining us as well, thank you for being with us and all our department, I have to say this one law enforcement is in one place who's taking care of our streets because everybody's in this building but week before we get to an important emotional presentation that we have I want to recognize another one that I sponsored a special presentation in recognition of women's month. Just mention that a lttle bit ago with this beautiful work. I want to honor doctor anna delmont a if she can come up with me. Anna ross. Doctor period thank you for being with us, if you could stand next to me and I want to honor her for her service as florida's first state surgeon general and the first woman and cuban-american to lead the florida department of health and for her contributions to public health. That's a big deal doctor. So today we honor doctor anna maria whose career reflects an extraordinary commitment to public health leadership and service to our community. she made history as florida's first state surgeon general and secretary of health becoming the first cuban-american, I'm going to say that a few times to leave the department of health. During her tenure she helped lead statewide efforts focused on prevention health equity and improving the well-being of communities across florida while remaining committed caring undeserved populations, not undeserved. Underserved populations, very important clarification. She continues to work through her leadership at baptist health and by mentoring future physicians as an associate professor at fiu, one of our own in miami-dade county. Doctor ross thank you for your historic leadership and compassion and continued service, keep doing the important work of public service and keep our communities safe, thank you and with that I have a few words I'm sure the mayor will want to say but in the meantime I will get an official proclamation. >>mayor cava: thank you for bringing this important recognition, I've had the pleasure to know doctor ross for decades and we've worked together what did we say? Through many lives and she's always been as you see her today and incredible role all four young women, men touring but also for everyone who cares about our community not only is she a top ranked physician focuses on community wellness, women's healthcare and we are so proud of what you've done here and also as a national leader so your work has spread beyond miami-dade, beyond florida. I think globally for sure because you stood up for making sure people have access to healthcare no matter their situation so I'm grateful to you personally for your friendship, for your mentorship, for your kindness and setting an example for the whole world. >> thank you so much, I'm honored and as medical director it's my privilege and my honor to serve the whole community especially just outside your door in our street outreach, I'm professor at florida international university college of medicine. I believe the health of women is of interest to the health of the community and I'm here to serve so tank you so much. >>chair: round of applause and with that be it resolved the mayor of the county, county commission and myself as CHAIRMAN Of the board and on behalf of miami dade county almost 2.8 million residents proclaimed today tuesday, MARCH 17, 2026 as doctor anna maria ross day, congratulations doctor. >> b >>chair: thank you again doctor for the work you do. Keep doing it. You've got a lot of energy so keep it up. All right, I know. This one here? All right. Our last recognition this morning is one that we don't do very often and it's probably a good thing we don't do it very often. But it is a presentation of the vilomah award to the officer everyone in this community and many communities no and continues touching everybody's heart day after day and that's sees our echaverry. This award is nominated by commissioner gonzalez, thank you for doing . I want to thank the family of y of caesar for being here. Known to many of course as echy and echy was the embodiment of public service. He cared about his community, cared about people he impacted in doing the right thing and he lives on and not only does he live on but his public service lives on his family, sheriff if you could join us as well. I'd like to have, and steadman. Anybody else from the police leadership team. Then of course they sheriff can call but before that I'd like to give the sponsor opportunity to introduce the board. >> this is a special award and it's a difficult award. So I want to start with a difficult cnversation. Jesus is sitting with his friends, his best friends and his friends are hearing from him where he's saying he's going to go on and he's going to suffer and he's going to be killed. For the betterment of mankind. So peter who is bold he stands up and he tells jesus, he says no, that can't happen. That will never happen, I will not allow that to happen and if you've read this passage jesus looks at peter and he rebukes him. And he tells him to get behind him. Because peter doesn't understand the bigger mission. The reason that's a difficult conversation is because many times I put myself in peter's position and I think today we all feel a little bit like peter. Because when you think of a great man like caesar, echy, echaverry you think of a man who should never have been taken from us. Should have never lost their selves. Should have never lost her brother. But jesus knew something peter didn't know. And that's that you can't put out a light because of echy's sacrifice and the boldness of his family that is able to every day remind us not only of his sacrifice but of the light he shined when he was with us. There are officers today that are better men and women. There are police departments, entire departments that are more courageous, more caring and they are more giving because echy was that light. Christianity is the only faith where GOD became man and walked among us. A lot is said of the sons sacrifice because the son sacrificed his life so we can live and not enough is said of john 3:16 which is the father's sacrifice because the father gave his one and only son which is the ultimate sacrifice. So that we all can live. And with that it is my greatest honor to present to you family members, parents, fiancc the vilomah award because this award is about the light that continues to shine and will always shine because of echy and because of your strength to allow us to honor him and remember him forever. So GOD bless you. >>chair: thank you and we will call you up in just a second. Sheriff and I know my colleagues MAY want to say a few words, the mayor will say a few words in case you need to call someone else up to join you. >> I'm going to put him on the spot but I saw him earlier, jr ramirez please, front and center. Major veda, front and center and freddie. I called you three specifically because these are the leadership that was in place at one point or another during this entire time, these are the individuals that every day steer the ship. Out at all officers, deputies, I say officers because some are retired in this room, deputies, this is a living testimony of echy. This unit is a living testimony to echy every day and I'm proud to say in his name that you have never slowed down. You have served this community with honor and integrity going after the worst of the worst. You make him proud and you make me proud that you make this community proud. Thank you for what you do every day in echy's name. Families know that we carry him in our hearts every single day. part of this badge that I wear is echy's. Thank you for sharing him with us and for allowing us the opportunity to honor him as well. [Applause] >>chair: mayor, want to go first or last? >>mayor cava: as has been said the vilomah award is not often given. It's given when an ultimate sacrifice leads to commitments, investments to make a better world and truly the echaverry family represents exactly that. The inspiration that we have from echy lives with all of us every day. It was there at the time I was in the hospital with you, I was there with his fellow officers grieving the kind of solidarity that cannot be experienced except in this setting, truly remarkable the support that our law enforcement and first responders give in this time, every one of us. Holding you and through it all through the naming of the street, through the journey back to your home country, through now the twice annual pilgrimage that you make to your hometown in nicaragua to serve the children at community, you continue to shine that light. To sandra who is now a practicing immigration attorney serving, serving to our beloved parents who make these efforts twice a year to your wonderful fiancc sheriff's office as a victim advocate, everybody's serving in honor of echy and what he has meant to our community. to your family but beyond to the whole world so it is fitting that this vilomah award which is about taking pain and turning it into service and memory to make a better world, that is what they do each and every day and we thank you and for that I am grateful to the commissioner for sponsoring today's award, thank you so much. >>chair: thank you mayor and if the family can please join us. Were going to officially present the award and a photo and after the photo with the family commissioners we will call the entire family to come and join us for families photos as well, commissioner gonzalez will officially present. >>commissioner gonzalez: is my great honor to present you and your entire family the vilomah award on behalf of miami dade county and are great sheriff's office and on behalf of every single resident in miami dade and every officer, GOD bless you, thank you for your strength and thank you for sharing your son's legacy. [Applause] >> I want to thank the major, commissioners today and the whole department and our leaders and just being here present today is a testament of GOD's grace to continue with the strength for whatever purpose he has for us that we have committed to continue serving and to be able to honor my brother and continue his legacy I know he is with us right now so thank you. >>chair: you want to guide us, where is armando? >>. >> will will will will will will will will will. >>. >>chair: please hold will. >>commissioner bastien: here. >>commissioner bermudez: here. >>commissioner cohen higgins: >>senator garcia: >>commissioner gilbert: >>commissioner gonzalez: >>commissioner hardemon: >>commissioner lopez: >>commissioner milian orbis: >>commissioner regalado: >>commissioner steinberg: >>commissioner mcghee: >>chair: present. >> we have nine members present, we have a quorum. >>chair: MADAM Commissioners and all present stand for the invocation led for the first time since I took chairmanship I'm pretty sure by our MADAM Daniela levine cava so no pressure, can be short as long long as you like, I should have given you the warning but you have the authors followed by the pledge of allegiance. >> thank you for that honor, let us bow our heads. Today we ask that you bring blessings upon the members of the public and our commissioners as they way important matters of the day. We are guided by the spirit of fairness, compassion to resolve our issues through the spirit of collaboration and respect. With this amen. >> I pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under GOD indivisible with liberty and justice for all. >>chair: you MAY be seated. thank you for those words. Impromptu there. All rght, not an attorney can we move into reasonable opportunity for the public to be heard at this time. >> yes. >>chair: reasonable opportunity is now open, when I call your name please state item you're speaking on, name and address, you have two minutes to speak. I've got leonard hoffman and stanley young. You've got two minutes, state your name and address MR. Young. >> chaplain sandy on 500 northwest. Second avenue florida. Thank you for this time. >>chair: that will be used against you, don't worry. >> thank you officers for serving our community and helping our community, speaking on 11 a1 about entry. I was in jail, I was in prison and you came to visit me. Those are the words I have carried in my heart for over 36 years in three states to take the word of GOD into the prisons and jails to let the inmates know you made a mistake but that mistake shouldn't make you into something you shouldn't be. I believe in reentry. I support reentry. I'm going to fight for reentry. There are someone's I come along in our prisons and jails who do need our help and that is what I have dedicated my life to. To be a voice and a light to those who have turned a life around and now are wanting a second chance to get back into our community to make our community better than they found it. I want to leave you with this. Three weeks ago I was out in the community and I come across this encampment, this homeless encampment and I saw a tent in the woods and I called for the person that was in the tent to come out and this lady came out of the tent and very noticeable, she was six months pregnant. So I tried all I can to help her get into the shelters. That is what I do. Thank you, GOD bless. >>chair: leonard hoffman. MR. Leonard. Leonard hoffman, billing once going twice closed. Public hearing reasonable opportunity is closed. MAY we set the agenda at this time. >> I have a few changes, 2b1, commissioner orbis is adding this item to the pull list. 3b2 and 3b3, commissioner orbis adds these items the pole list. 4c substitute has been distributed this morning, you should each have a copy that will be added to the agenda as well, the clerk has a copy, 4c substitute. 8p1, commissioners orbis is adding this item to the pull list. 8p2, commissioner gonzalez adds this item to the pull list. 14a1 thru 14a5, commissioner cohen higgins is pulling these items. She also is pulling 1I1. I'm getting additional poles and commissioner regalado is adding her name to 8p1. I have additional requests for cosponsorship. 4a, commissioner bermudez, 10a1, 11a1, senator garcia cosponsor, 11a2 commissioner steinberg is cosponsoring, 11a4 commissioner 11a4 and 1485 cosponsoring and also commissioner regalado wanting to sponsor three b2, 804 and 1081 and I got word commissioner tran seven is releasing 2b1 so that will not be on the pull list so the items to be considered at today's meeting will be those written listed in the printed final agenda with additions deferrals withdrawals and scriveners errors noted in the items I just mentioned, commission will move all these items setting the agenda except ordinances for first reading, public hearings, items 6b1 of the public health trust and submission of the trust external audit for fiscal year 2024 2025 and item 6b2 in the following pull list items, item 1I1 and I think that item had a substitute. Item 2b1 3b2, 8p1, 82, 14a1, 154a4 and 15a1. A motion to set the agenda is in order. >>chair: seconded by commissioner steinberg. All in favor of setting the agenda signify by saying aye. All opposed, nay. Show the agenda hereby set, thank you for that commissioner steinberg. We're starting already, it's st. Patrick's day, happy st. Patrick's day everyone and with that MADAM Attorney can we start by taking up item 61 which is the joint meeting with the public health trust and board of county commissioners. All right, MR. Migoya and the chair you can approach the two wells and whoever wants to go first you can do it, you MAY have a presentation for us, do it how you've done it in past years which has been very expeditiously and resourceful, move quickly, fast. I'm kidding, go ahead guys. >> especially the people that grow their hair fast I don't know if we should be making those comments but we will start off with the chair. >> good morning MR. CHAIRMAN, good morning vice CHAIRMAN Mcghee, not an mayor and all the members of the sion. It is my privilege to be here here today with my colleague who has the privilege of serving on the public health trust board of trustees to present our annual report about the progress of the jackson health system. This annual meeting is one of the most important commitments that we do every year. It gives us the opportunity to showcase, to bring forth the accomplishments of the jackson health system over the last year and to share the goals and visions for the year ahead. As CHAIRMAN Of the public health trust I take this very seriously. My responsibility to ensure this taxpayer-funded system operates with the excellence accountability and steadfast focus on the people of this community. I say with full confidence our neighbors across miami dade county are fortunate to have the nation's best doctors, nurses and other medical professionals in their backyard at jackson. I can assure you this board and jackson's leadership team never loses sight of what is in the best interest of our community and our taxpayer owners. This year marks a moment in our organization as we prepare for a leadership transition. For the past 15 years carlos migoya has been the driving force behind jackson's remarkable transformation. He arrived in 2011 and came with a bold vision of determination to strengthen our landmark institution and he certainly has succeeded. Because of his leadership jackson today is stronger, more innovative and better positioned not just locally but nationally. His legacy will be one of growth and relentless commitment to excellence. Carlos has always believed strong organizations are built by strong teams and by developing the next generation of leaders. We are fortunate to have such a person here with us this morning, doctor david zambrano. And he's someone carlos has meant toward, prepared and interested in carrying the mission forward. Before I turn over this microphone to crlos I want to thank my public health trust colleagues who generously devote their time energy and expertise to ensure the highest levels of accountability and transparency. It is an honor to serve along side you. and to each of you are distinguished board of county commissioners thank you for believing in jackson and the vital role it plays for miami-dade county. With that is is my pleasure sadly to turn over the microphone to carlos migoya. >>chair: I understand what you meant by sadly. The last time in this joint meeting. >> this is what happens when you build friends over the years. Meta-mayor commissioners thank you for the opportunity to once again be here before you with what I refer to as our annual state of jackson health system address this past year has been defined by progress, we've expanded access to care strengthen darkling radical programs invested I innovation and deepened our commitment to serving every resident of miami-dade county regardless of their ability to pay. We ended the fiscal year earning a modest surplus and for the 14 here we have achieved that and in front of you will have our annual auditing statements for you to accept and we have grown thoughtfully and itentionally ensuring our community evolves so too does our capacity to meet its needs. But if there is one constant in healthcare particularly for public health systems like jackson is the persistent headwinds we face. One of the most significant issues facing us is property tax reform. As you know and referendum could prove the elimination of nonschool property taxes effective OCTOBER one of 2027. That one's already clear the house and if enacted that proposal could negatively impact jackson by approximately $83 million a year. While the legislature adjourned without taking action all indications suggest some form of property tax bill will be approved in a special session later this year for a referendum this fall for a system like ours our property taxes directly support trauma care, the care delivered to babies in our nicu, bhavioral health services and access to our most vulnerable neighbors. A reduction of this magnitude would have dire consequences and we are committed to educate lawmakers on these potential impacts the expiration of enhanced affordable care act subsidies at the end of 2025 also poses significant risks real marketplace coverage has grown from less than 4% of our patient base a decade ago to more than 18% today because we are a non-mitigated spending state and if coverage declines we could see an increase of uninsured patients representing a potential worst-case revenue impact of $40 million a year. We also continue to advocate for other critical programs to help us fund our mssion. Three years ago we began a initiative that's been driving operational efficiencies lightning up processes and building a stronger more sustainable foundation. To date these efforts have a total impact of approximately $324 million a year or about 10% of our operating budget. Both in savings and in revenues. Our goal is to sustain that momentum by cutting 3% of operating expenses annually equating to an additional hundred million dollars a year while protecting quality access. Since the day I arrived 15 years ago the health system has operated at the intersection of margin and mission. We've learned how to adapt to uncertainties, innovate without compromising quality and how to stretch every public dollar while delivering world-class care and we get better ad stronger every year. We have remained steadfast in our commitment to smart intentional growth. Last year we strengthened our process in the community by opening a new diagnostic center to complement our existing urgent care center in coral gables creating untrue continuum of outpatient services. In north miami beach our specialty practice located near the urgent care center and just a few miles from jackson health medical center serves as a model for coordinated patient care closer to home. Next month we will open our first jackson express care on collins avenue in south beach an ideal spot for local residents and tourists who need quick convenient medical care so they can get back to enjoying their time in our community. These are not isolated projects, they are part of a deliberate strategy meet patients where they are ensure a high quality care is accessible convenient uncommitted rent our plan is to grow jackson's outpatient footprint thoughtfully and strategically in the years ahead yet even as we expand access points across the county we never lose sight of who we are at our core. From transportation and trauma to cardiac surgery and neurosurgery to pediatrics and rehabilitation to high risk maternity care our health system remains a destination for complex lifesaving care. We are very proud to serve as a safety net and a world-class academic medical center simultaneously. In just 37 days we will open our new emergency room at jackson memorial and it will be one of the largest if not the largest most advanced in the nation. We are currently working through our final test preparing for opening day APRIL 23. This $400 million facility will transform how we deliver emergency care by featuring specialized areas expanded capacity and improved throughput. The building has been designed to enhance care for all the patients we serve including inmates and those experiencing behavioral health emergencies by incorporating distinct secure and specialized areas within the same building. This will allow us to make complex needs without compromising access compassion quality and safety. Most importantly it will create a safe opening experience for all patients and a better more efficient environment or our care team members. The jackson memorial emergency room is the front door to 70% of our patients and we know how important it is to have first impressions there. This will be the best in class environment that reflects the exceptional care of our patients that our patients deserve to be in each of you have been invited to a special event hosted by the jackson health foundation in the new emergency department APRIL 16 so we would love to have each and every one of you there to enjoy and celebrate with us as the next era of jackson emergency care starts finally this will be my last year standing before you in this role as ceo, sorry I have to do this but it just came eventually, it's been one of the greatest honors of my professional life to lead this institution to work alongside all of you. I'm grateful to each of you and your support not just of being one of the health system so dear to wallace. I am 100% confident jackson will be a beacon institution we are all proud of. Under the leadership of jackson's next ceo which is here now and will speak a little more on our half, I'd like to hand the microphone over to david to say a few words. >>chair: while david is conduct i am intrigued that you have carlos still work. David. >> I will be brief, thank you carlos, thank you CHAIRMAN MADAME mayor and commissioners. And friend carlos migoya for his extraordinary leadership at jackson health system the last 15 years. He has masterfully rebuilt jackson and helped shaped it into the strong trusted institution it is today. His vision and dedication have created a lasting legacy and positioned us continued success in the years ahead as I step into the ceo role JUNE 1 I look forward to working with each and every one of you continuing to push jackson forward. Jackson as you know is a renowned institution centered on clinical excellence and the most passionate team of 14,000+ caregivers routed by mission to serve this community in a way no other health system does. You have my word that will not change. Looking ahead as carlos shared we are positioned on expanding our outpatient services while continuing to strengthen our long-standing partnership with the university of miami health system. We are stronger together and the alignment has never been stronger than it is today. Partnering with you health on an economic impact study and highlighting the district health district for economic growth in miami-dade county and across florida as the region's only academic center. The health district annual economic impact in miami-dade county is 8.9 billion generating 46,000 jobs, also noteworthy is that jackson offers accessible job opportunities that do not require a four day degree yet provide above average earnings. The health district is a pivotal community with research on medical education and we are committed to working together on a master plan to ensure its continued growth and evolution for years to come. Once the report is finalized we will send each of you a copy. We also want to remind you that our annual day of giving one day for jackson is a few weeks away thursday, APRIL 16. On that day we celebrate the impact jackson health system as throughout our county. We issued a video about keeping with time we appreciate your time this morning and we would be happy to take any questions, thank you. >> this is interesting from the outgoing ceo to the incoming ceo, the full head is what's getting me. But I do want to take a moment to recognize my former colleague to the ci oneself, senator alexis, are you guys done with your presentation? This is the longest migoya is ever spoken on that podium so colleagues, as I've prepared to officially adjourn the joint committee I'm sure you are eager to say a few words to this very short bald man in front of us but I am if you have questions on the joint meeting itself I will recognize you now, if not okay, let me finish. If not once the joint meeting i'll ask all my colleagues to join me by the well or a special recognition of carlos so on the joint meeting itself. >> I want to commend you both for carlos, you've done a fantastic job with the incoming ceo to celebrate you and we don't always agree but I know where your heart has been at jackson. David quick question. Now that we have the issue with the formal care act subsidies that MAY be disappearing, that obviously is going to go on jackson. What are we looking to do with what is happening in washington, can you gve us a report on the impact to this community. >> this morning we're speaking with our cfo on what we are seeing so far and we're watching the situation closely. We've seen a transition from aca plans to medicare and seen a slight increase in our unfunded. As MR. Mccoy has shared our focus continues to be on how we continue to advocate in the state and federal levels every day ensuring all our subsidies remain intact looking within the system for constant deficiencies to make up whatever differences, a continued plan is to watch this closely and continue to figure out ways to support our communities. >>chair: so as of right now we don't have an action on impact jackson then, is that okay. >> we're watching it closely, we don't know what the full impact will be as w don't know each of these patient transitions either unfunded or another fund for managed-care. >>chair: have we dne studies to what the potential impact on transit could be? It's to understand the impact this could ptentially mean to our system and to miami dade county since we are the largest provider. >> our analysis shows in the worst impact these all transition to unfunded. >>senator garcia: it's incumbent on all of us to stress the importance of a community that a lot on subsidies to ensure we grant as I understand the cncept if you eliminate them I think it's on the federal government whether it's what they said as a transfer or pay the recipients or the client, pay them their premiums directly, do something to abandon this community. With a deep impact to the gr of our budget and also jackson will have to come up with something in a tough budget year we will have to figure something out quickly so just want to bring that up and thank you for keeping this on us. >>chair: commissioner from district 8. >> were going to reserve comments on their transition as well so I will certainly reserve those comments I want to piggyback on what senator garcia raised, at first thank you for mentioning the tax rates we are anticipating and how it will affect your budget right now, it's at 83 mllion. We anticipate between I think $100 million into your budget. And let me just say this is the impact we anticipate, the demand we have in place in order to prepare for that. So my comments are simply too high like that for us saying 3% is I think operating costs and the reduction of those to prepare so thank you for that. Just mentioned in response to senator garcia's comments, is that in addition to or is that the same? He was talking about something different, I could be wrong. Are these two separate cuts, two separate anticipated cuts to the budget? >> when you talk about headwinds there's all kinds of different headwinds. The tax cut if a bid at 100% which at this point we don't know but that could be the worst case, 83 million the aca subsidies are an additional $40 million and as of right now we are also dealing with the fact that cms is not doing a repayment program which is a supplemental program in the state of florida which is $3.4 billion to the state which are 150 million of that to jackson itself so that's a worst case scenario. These are normal headwinds we've been dealing with the last 14 years so we talked to people in washington and thank GOD we have some people in power in washington that we have in contact with that we are daily talking to them so these are the normal headwinds which is why we say typically a 3% reduction. If that depending on what happens with the property tax reform which obviously we wuld know later this summer and of course in the fall we would have a year to prepare for that, that now 3% would not be enough, we have to be five or 6% ripped like I said the last 2 and a half years we cut 10% so if we need to continue to look for ways to be more efficient don't get any additional revenue for the job we do and in fact we get less revenue we've got to be more efficient how we do things to be able to maintain profitability that's what we do for the last 18 years that's the kind of thing we will continue to do. >>. >> commissioner from district 1. >>commissioner gilbert: I don't have a comment, I just want to say I came from the county attorney, you all don't know big abby abby was the former county attorney for years. >>chair: commissioner from district 11. >> I'm listening attentively to the discussion, you mentioned there MAY be a $830 I guess shortfall should there be removal of the property taxes. The house from what I understand is the removal of property taxes. If that 83 million factoring in 100% of property tax removal or are you factoring in if it were to pass only for the homesteaded properties. >> it is strictly for the homesteaded properties. At 83 million is what the house has passed and that seems to be obviously that maybe what happens, it MAY be worse, it MAY be better. >>commissioner gonzalez: thank you. >>chair: any other comments for the joint meeting? Not an mayor. >>mayor cava: thank you, I cannot resist the opportunity to say what an incredible journey it has been serving with you sir down to the well, we're going to speak there? I will speak again, thank you so much. >>chair: we don't have to take a formal vote or anything so please join me for a special presentation. >>chair: are all the commissioners here? Cut him some slack. Just this guy is something special. Not an mayor, you want to do the whole thing? Can we quiet down in the back as well. Sergeant. All right, carlito. We wanted to the full body as a county wanted to recognize you today for of course your many years of dedication and leadership. Just a small token of your appreciation for everything you've done. So we have a couple days. We have, can you open this for me? It's not fancy, please, it's meaningful but it's not fancy. We have an official global that represents the incredible transformation of the jackson health system that you've turned jackson into a globally recognized institution and I personally selected because it also reflects something many of us know about you personally which is your love for traveling the world and learning so we on behalf of the county commission I wanted to present to you this very meaningful award and of course we're also going to be presenting to you the official t2 miami-dade county. [Applause] That and $12 might get you a motel. Maybe. So this key is symbolic for many reasons, and it's something simple. No matter where life takes you next you will always have a home with us at miami-dade county. Your leadership health died jackson through one of the most challenging financial period in history. Those are very true words. You showed a public health system can serve our most vulnerable residents while becoming a world-class health institution and finally on my behalf thank you not only for your leadership and service for this community but my friend, congratulations and yur impact will be felt for generations to come. [Applause] >>commissioner regalado: thank you for your service, you are such an amazing leader. We got to work together in the city of miami and you worked for blackberry on a dollar and changed the course of the cty of miami and I've learned so much from you during that crisis and I've ben blessed to be your friend. We all have personal relationships we dn't get to talk about that much when people come up before the podium so now you don't have to do that anymore I get to talk about you in a sense that wen I was a school board member in the want to thank you for that, when I said I was running you were the first one to write a check without asking me for it, even beat my dad to the punch and one I was grappling with revealing my daughter had been diagnosed with autism you were the person I called and he told me this was my opportunity to make a change and I want to thank you for that, it's changed my life, changed my children's lives and the lives of hundreds of autistic children so thank you for being such a strong advocate because your leadership comes from your love for your son jackson and that means so much to so many people who were given a difficult task and turn it into advocacy so jackson will always be your baby, most cuban men are in 57 so I know what he's talking about and he's jealous because you where a racecar driver and he was not. >>commissioner bermudez: first of all you are not followed complete challenged. It's good hair. Not only guys with hair look good but thank you for your leadership and I want to thank the senator and bard. He's not followed? Challenged but I am in for the great job they do this but in particular I want to thank you because you have been truthfully for many public servants a leader and example of this community and I remember first time in the city of doral your predecessor, we had a discussion about a potential hospital out of this great new city that just started individually that first hospital, for many years certainly public hospital was interested at 12 in the city of doral and your leadership skills turning it around at that point a very difficult situation. That we should emulate. So I think all of us and many others around here heard from you, most of your leadership skills in tough times. That's a hard to do. Being a leader in tough times is exemplifies public servants which is what you've done with your leadership. I want to thank this woman personally on behalf of myself and my family for being there in a difficult moment. And jackson I can attest is an example not only for the sole state and for this community and without your help being here today I know my wife thanks you and I thank you. Because of your great service and I know a lot of people many times don't understand what this hospital means. The senator does because she's from here but they don't understand how important it is to have a public health system in such a large area as is miami-dade county. You've done a great job, keep on traveling, enjoying and thank you. >> I thank you on his behalf because I could have not dealt with his appointment on the board so I thank you to fort commissioner bermudez. You had would have been appointed just for the record. >>commissioner bastien: thank you so much MR. Chair. So you know that jackson has a special place in my heart. Because I spent 31 years working there and I've had such great fun there. I remember when you took the rain that jackson promised to change it for the better. And then you accepted without I think at that time, if I recall correctly. I like someone who keeps his word. You make the promise and you kept your promise. And for that I thank you. I thank you for turning g and h into a global recognized health institution. And since as we all know health is wealth, and launched a campaign called health is wealth and it means your leadership contributed to the wealth of thousands and thousands of our residents for the last 15 years so I thank you for all that you do and I thank you for being so smart and leaving jackson in capable hands. So that takes leadership and you said it correctly, you are as strong as your team and you have had a strong board and I'm so pleased to see the senator and the rest of the board that have served with them because I presented on the board and some of them have been there forever. They've been there for a long time so you are right when you say that you are strong and you've been blessed with a strong work. So I wish you continued blessings in all your endeavors and MAY GOD keep you safe and healthy and we know you value help a lot when you exercise, be safe and healthy in his embrace. Congratulations. >>commissioner mcghee: to my bold beautiful brother, want to say personally thank you so much on behalf of miami-dade similar to what we've heard there have been many nights and days I called you in the community and not once did you ever shy away, you stepped up even more on that health as well as be heard and secondly I want to say this to you. Days you and I sat and had conversations on the office away from the office, I just want to say thank you. Because those are the type of conversations I think that goes to help mold and inspire and push for agendas that could be beneficial. To the entire community I asked the sadist, I know you have the key to the county. But I'm sure if you were to get a parking ticket the mayor would make some phone calls on your behalf. >> there's been comments that have been made which reminds me of a story. So napoleon had some statues made and it was for him and all his generals. And he calls in the artist and he rebukes the artist in front of everybody and says how dare you make my statute shorter than the others. Then the artist is shaking because napoleon was napoleon and the artist was like sir, I made it accurate to size. Napoleon says you fool, don't you understand that a man's height and stature is not measured by the distance of his head to the ground but of his head in his heart to GOD. And with that being said or a giant among men, thank you for everything you've done for the residents of miami-dade county real we are all able to stand on your shoulders to see a bright future because of everything you've done so GOD bless you. >> MR. Migoya it's been an honor working with you, when you called me to say you were leaving I thought I told you I was going to hang up the phone because I was not ready for that news but you've led jackson through extraordinary times, you've taken it to a new level with your leadership until in a hospital way the employees admire the work that you do. That is indicative of a great leader so thank you. Your work and service to our community helped leave a lasting legacy. Thank you for always supporting our initiatives, thanks for your help and staff on project pink to help women across miami-dade county. Very thankful for your support so congratulations. Keep working with us and helping us out. Because we will be calling you I'm sure so thank you for your service and congratulations for your time at jackson. >> all the sentiments that have been said we echo. We issue a farewell but a sincere thanks for your leadership, service and what you've done for this community at large because jackson is part of our community and every person and every patient and every employee is in service benefits from your leadership. It's been someone said you've been through some of the toughest times with covid and you haven't stopped. We want to you know basically at this point we just want you to stay in touch. Help guide us and continue doing what you're doing because I know you're not going to just do nothing, we wish you the best success in whatever your future endeavor will be. You're going to have to call us in soon and congratulations. >> we been friends for decades and I want to thank you for your service. But I also want to say most people don't realize how you are a fearless advocate in tallahassee. I prsonally was able to help you, you sent in my office begging to make sure what we were doing would not impact negatively. I'm grateful to you and your team for having had the courage, it's not easy yet you never gave up so I'm grateful for the fact you always have fought for miami-dade county and what's best for us and our public health systems so congrats on an incredible journey that has brought you throughout all of your roles and responsibilities. But honestly I know that as my colleagues have said we know you're not retiring, you couldn't possibly be your brain trust is something we all need so I know you'll be back. Love you. >> were all saying thank you but you are an example of leadership and what one individual can do to change an entire community and it's not easy to pass and hold onto that baton. Even passing the baton is correct on so many levels but jackson is our public hospital and for many years particularly frankly it was an embarrassment to our community and you came in and transformed us from being a world-class hospital to what it is today and as you know carlos I was a grant and we didn't have any money for immigrants in the 80s and didn't have insurance. Jackson has been a small health center and I remember being at jackson and being somewhat embarrassed. Thank you for transforming our hospital into a place where we end I can be proud of our public hospital, that is your work, thank you so much. >>senator garcia: your rights, jackson needs to be a hospital of last resort and now it's a premier world-class hospital where we have transplant centers, children's hospitals, world premier trauma center. The research that comes out of jackson, carlos, you for the work you did. It you've made this transformation in a short time and I'll never forget what you said to me in my office and I asked you are you a dagger, what do you do at jackson and my brother was like, I was because I didn't think he could do it and he absolutely did it and together we've been through a lot of battles, shared payments to occupancy in beds and everything carlos had at tallahassee, I commend you for the outstanding work you've been able to accomplish not only for the commissioners that are here but for our community. You MAY have been able to transform a hospital, but the city looks better with a million of us and that says a lot about an institution, about how you ae and we thank you very much for the work you've done for transforming the hospital and making sure jackson is not a hospital of last resort, it's a hospital for everyone in this community so thank you so very much. >> this is an incredible opportunity for me to say thank you for your service. And what you've built we all appreciate but I want to thank you for what you've built to continue the legacy. The team we have running jackson under your leadership is world-class and that's in your hands and as we passed the baton to people we need to thank you as a community for building up the future objection and for your leadership and your hand will not be far from the continued upward progress of jackson but serving other elements of our community that have your touch as well. You continue to cultivate world-class care that should be there every day so thank you for what you've done today. >>commissioner gilbert: you said be nice? David, should I be nice? i will be nice. We had lunch yesterday so I sent all the personal things yesterday. You know I love you, that goes without saying. His leadership is that he built the system. There are millions of people as jackson has said and we don't know their names, they know the system that had somebody who in their worst moment could come to a place and get the best care. That system transforms lives. We built a system that allowed children to be born, allow them to have dignity in their care. I appreciate that because I understand all our time in leadership is fleeting. Take the lesson from him and to build a system that endures and serves the community. I appreciate you, thank you. >>chair: I know it wouldn't be complete, the mayor is still pending. Mother. >>mayor cava: my relationship with jackson started before your tenure, always as an advocate for the uninsured and underinsured and I was skeptical like others when you came on board but what you've proven from the start is you believe you could do both. You build a world-class hospital that was financially stable and continue the core mission of serving those who were uninsured. That is a miracle. I also want to say I was given the easiest job in the world to serve on the committee that did your annual appraisal and compensation. i don't know how I gt this job but every chair has given me this job. What an easy job was that? There's a plan such a smooth transition to the grateful doctors and that is a miracle to so I'll end with this to say we bonded through cobit, bonded through reform of our corrections system. Never forget those times. Mostly we bonded over our grandchildren. So very special, thank you. >>chair: did I MISS Any money? Before we adjourn which this wouldn't be beneficial, I know it's clichc definitely have big shoes to fill and I trust that you will. I think it's taken decades to get to where you are. Before I present this proclamation my colleague I'd like to have join us someone that I know you will not have the success you've had without this person. Your work life, you are a rock of the public health trust, esther please join us. While I know today is of course recognizing MR. Mccoy, I mean it. I know esther thank you for always taking the calls went abuelo is skiing in aspen. He always answers the phone. He's always on the slopes. But we all can attest of course with you that your success is only possible due to his entire team, due to his support of the trust which most of which are here. And of course with the person that keeps them all in check. I need the same thing, someone tells me what not to say. so while this is for carlos as he nears his end as ceo this is very much yours as well so with that be it resolved that the mayor of the county to my right myself as CHAIRMAN Of the board and members of the board of county commissioners and it's 20 million+ residents do hereby declare today to stay as carlos migoya day, congratulations. [Applause] For those who know me well I don't do well in these kinds of things, I don't like talking about myself, don't like hearing about myself. But seriously and by the way on fundraising right now with 20 bucks to help the chair get a haircut. But seriously, when I first came and when I first was interviewed for the job at jackson and they said you are a banker, most people forgot I was a banker, the manager was there for a year but they said you're a banker, what do you know about healthcare, I don't know about healthcare but I know about people. Any major organization is involved in getting the right people and you're right, when you say it's not about me. It's not about any individual, it's about operating a system that survives all of us and creates a level of pride in every employee and it becomes patient centric for the right reasons. Healthcare for our community. For me it's a career job. It if it hadn't been a career job I wouldn't have taken it because I didn't know if it was going to succeed or not. I took it because it needed to be done and I thought it needed to be someone local that understood the needs and value of jackson, you know a lot of my family did the jackson job but a lot of I think right nw I don't know, I sill don't know what I would have done, we can talk about what needs to be done moving forward which is we've come a long way and david's not filling my shoes. He will do a great job. [Applause] For some people that say I'm going to retire and do a couple more, I already traveled plenty. Miami is my home. I've said if I got the job at jackson one of the biggest legacies I could leave this city and it has been. I think there's a lot more to be done for the city and you guys are the perfect example of what needs to be done for the city. Many of you have known well before we have relationships that go along way. I cherish all those relationships, in very different ways. And I'm very honored, I was not expecting this to happen. Actually from this guy over hear who he and I have a good personal relationship trying to put these things together. Thank you so much MR. CHAIRMAN and commissioners. And MR. Vice chair but seriously, miami has a lot of great things that we built, miami has a lot of great things we need to be in the future and you will continue to grow, it takes a lot of infrastructure. Education, presentations. Housing which is a big job in the workforce housing. It you know I care about workforce housing and education and it's just some of the things that jackson continues to provide housing and education for its people in this community. To learn more in the next few months but frankly thank you for the key, but I'm not going anywhere, I will stay right here in miami dade county. I will be here and you will see me and if you will have me I will be providing input and work with him making sure we continue to build jackson. Thank you for this honor thank you commissioners. >> if the board can join us for a photo as well. And then hold that. Get them on the board too. Can we get his award, jasmine, can we get with it? And if carlos, if any of carlos staff is here. I know I have esther but if carlos staff is here please join us as well. >>. [Applause] Is. >>chair: alberts, albert. Can we raise my microphone up there? Raise might not be the right acterization. Who did that, that worked. Commissioner bastien, teacher, albert is calling your name. Talking to your supervisor. If I can, I'm going to go ahead while jackson is still here and take up items 1481 through 1485. Commissioner from district 8, you are the pulling commissioner on this. The collective bargaining agreements. >>commissioner cohen higgins: I'm fully supportive of the items, I pulled the items for the uncomfortable conversation we need to start having as a board as we go into note negotiating new collective bargaining agreements in miami-dade county. This one I know is at 4%. I understand if someone jackson can approach to confirm but my understanding is you are all in the four lack of a better terminology last of the working of the collective bargaining agreements being negotiated. This is not the start of a new collective bargaining agreement time period so I think that we need to have a conversation as a board on 4% and whether or not that's sustainable or miami dade county considering the tax cuts we know are coming. The estimates are very rough at $930 million. These cst-of-living adjustments are deserved by our hard-working eployees but we will have to make difficult decisions in the future as we negotiate new collective bargaining agreements and I am sure the 4% is sustainable so to jackson, is it, is my understanding correct you are all on the tail end of the collective bargaining agreement cycle for lack of a better terminology being this is the last in line for the new negotiation period commences. >> just like the county we are on the same three year term and this is our last one. It's different from the county three years ago. When you agreed to contractually do three, three and four, 3% first year and 4% the last year we did the first year we dd increases of cost of living between eight and 10% at that time. It was the right