Assembly Standing Committee on Health

Okay. We'd like to go ahead and convene the hearing, please. So please take your seats or take your conversations outside. Okay.

Also, Members of the Health Committee, please come down to the hearing. We'd appreciate that all the Members of the Health Committee come down. Okay. Before we begin the hearing today for SB 326, which is the only item we'll be hearing today, I just want to make a brief statement. We seek to protect the rights of all who participate in our legislative process so we can have an effective deliberation on the critical issues facing California. All witnesses will be testifying in person.

We allow two main witnesses for a maximum of three minutes each. Additional testimony will also be in person and limited to name, position, and organization if you represent one. All testimony comments must be limited to the bill at hand. We do have a substitute Member, Assembly Member Diane Dixon, and we'll be replacing Assemblymember Joe Patterson for today's hearing only. With that, we have one bill. We do not have a quorum.

So I would really appreciate if the Members of the Health Committee could come to Room 1100 so that we can establish a quorum. But we will begin the testimony with Dr. Eggman. And please go ahead. Do you have witnesses with okay. Okay, thank you.

I do have witnesses. I would like to bring up Director Baass. And I think we're going to have our friend Matt here. We've gone too long for Mayor Steinberg to still be here. So. Not that Matt's a plan B. Matt's just a fine substitute for Darrell Steinberg. A fine substitute for Daryl Steinberg, just like Dixon is a fine substitute for Mr. Patterson. All right, so thank you today for hearing this incredibly important bill.

And I think I just want to start off too by thanking you, Mr. Chair, and thanking your staff for the hours and hours and hours of work that has gone into this. When the Administration and I started planning this some time back, we knew this was going to be a big process, and it would take a lot of time to get to this point where we would actually begin the hearings.

Because anything that you do after 20 years indeed takes everybody coming to the table to be able to work on it. And I think, again, it does not come in isolation. As everybody knows, we have been doing a Yeoman's kind of job on trying to redo where we find ourselves, right? Redoing, you heard me here a couple of weeks ago, redoing the LPS, we redid CalAIM, we did CARE Court last year, we did the Youth and Behavioral Health Infrastructure Force.

We've done a lot to really try to touch this area. And this, I think, is just another kind of massive piece to go along with this entire continuum of care. And I think it's really easy when we look at things like this, to look at it in isolation. I watched part of the last informational hearing you had and we had one in the Senate as well. And it's hard because, I mean, change is hard for anybody, right?

And when you think about what you have and what you may lose, those things are frightening. But what we do know is that too many Californians are losing right now. Too many Californians are finding themselves without services on the streets in ways that are just unconscionable for all of us, I think, for us as elected, for citizens walking around and for those who are suffering the greatest. I heard a lot of conversation about we're not taking people of color into their impact.

But as we can see, the amount of people who are living with severe and persistent mental health issues are overwhelmingly people of color. We need to put them first in line and not be just an afterthought. We need to focus on those that have not had the services that they deserve. When Darrell was here, he would talk about they just did a big sweep on C Street where they had a massive encampments and offered services and were in there.

And out of all of the people that they encountered, one person was on FSP, only one. And we know that's one of the greatest things that we can do to really help people from getting to that position is having more on that FSP. We know that works, we know that works across the state. So let's be able to do more of what's working and maybe less of what's not working. So again, I want to thank everybody for all the work.

It has been a long, hot summer coming on this, a lot of meetings. And again, a huge thank to all of you. And you've all known me, you've seen me come before you years and years and years working on behavioral health issues. And I like to think for all of us when we come into elected office, right, we think about as kind of our moment in time, our moment to meet the moment as it's presented to us, right?

Those who have been in office during war or during other kinds of crisis. You have to think like what do we do in this moment when we are sitting in positions of power? And I really think repairing our mental health system and really improving our continuum of care is what is facing us right now. And so I want to thank all of you for being partners in all of this, all these long years and years to come, right? Because my time here is almost up.

But your time here still has to go and you have to continue this work. But this is a major piece of, I think, what we've been working towards. As I heard folks say before, we have really expanded Medi-Cal. The amount of people without any kind of health care has dropped down to less than 20% in California. Those are good numbers. Those are numbers that say we need to relook at how we're advocating our money.

So at the end of the day, it's going to go to the voters because it's something this big needs to and so are we saying that we're going to focus more? Yes, we are. And the state is saying that we're going to take greater accountability of how that money is spent, how that money is focused. Have the county's done a horrible job? No. But they've all worked by themselves.

And we need to kind of put this up to a larger level, have some real evidence based, and whether that's community evidence based, I mean, there's all kinds of ways to know what works and what doesn't work and how do we make that bigger? How are we able to take programs that work and send them out to counties that may not have that same planning capacity? I'd also like to say, I heard a lot of folks talking about we're taking the power away.

Every local community, every county is still going to have their planning process. None of that is going away. All of those folks still have the opportunity to come to the table in their own communities and be able to make these cases. So anyway, yes, we are shifting focus to really be able to help those who need help the most. And yes, we think there is enough services to be able to fill in some of those spaces.

And some things that we have become accustomed to, we may not be able to do anymore because those may be a bigger luxury than the crisis that we're facing right now. So with me here today is our partner, Director Michelle Baass, who's going to walk us through this a little bit more about the buckets. And then Matt from SEIU will also be talking.

Thank you. Good afternoon. Michelle Baass, Director of the Department of Healthcare Services. As you know, and has been mentioned by Senator Eggman and earlier today, since 2019, the state has embarked on significant investments in the behavioral health space, over $10 billion. Whether it's the Children Youth Behavioral Health Initiative, CalAIM, our Behavioral Health Infrastructure Continuum Program, just for examples, we have a whole slew of initiatives that are underway.

This proposal today is really intended to address some of the remaining gaps that we see in our community behavioral health system. We were here to talk about SB 326, but there is also AB 531, the Irwin bill related to the behavioral health bond, the general obligation bond. But just specifically with regard to SB 326, some of the key pieces in this bill really relate to rethinking of the Mental Health Services Act.

Then some key pieces related to just rethinking behavioral health at the community level generally, and kind of the planning process and the ability to have a little bit more transparency in terms of outcomes and data. With regard to the MHSA SB 326 essentially recasted it to the Behavioral Health Services Act because we are adding the ability to use MHSA or BHSA dollars for individuals with only substance use disorder needs.

We are really modernizing the local categories of funding for our community behavioral health partners, with 30% going to housing interventions, and we spoke quite a bit about that this morning. 35% for full service partnerships, really recognizing how important this model is and really improving the trajectory of a person's life, as Senator Eggman mentioned, and really providing some standardization for our FSP programs and the levels of care for how those services are delivered.

35% for behavioral health services and supports, and in that bucket is where the early intervention dollars are included. And that's 51% of the behavioral health services and supports bucket, and of that, again, another kind of category of 51% of early intervention for our children and youth. We've also added some recent amendments to allow counties the option to move some of the dollars between the pots, depending on their local kind of needs and the local planning process to provide counties with some of the flexibility that we've heard over the course of the last few weeks that is very important and necessary. We've created some new statewide led initiatives, so adding 4% for population based prevention at the California Department of Public Health.

This includes statewide population based efforts, countywide population based efforts, and community driven population based efforts as well. 3% at the state for workforce initiatives and a portion of those dollars, 36 million annually, will be used as part of our BH-CONNECT waiver, which we spoke a little bit about earlier today, to really draw down about close to $500 million annually for behavioral health workforce.

So a significant opportunity to use some of these BHSA dollars to draw down essentially ninefold almost in terms of federal dollars, creating over $2 billion in workforce opportunities with BH-CONNECT over the five year waiver period. And then reducing the amount of state administrative dollars from current law of 5% to 3%, recognizing the need to ensure dollars are going towards services. We spoke a little bit about earlier today about the county integrated plan and how we are re envisioning the three year MHSA planning process, which today is very focused on MHSA dollars.

Really rethinking about how we can draw all of the community partners at the local level, whether it's Medi-Cal, managed care plans, local public health jurisdictions, continuums of care, child welfare area agencies on aging, just for example, to really how do we pull together all of the stakeholders at the local level who are really contributors to the community behavioral health space?

How do we leverage those programs and opportunities and all the various funding sources to really plan and come together with both statewide outcomes and metrics for behavioral health and then the local outcomes and metrics that really are tailored towards an individual community and county. Because we know that our 58 counties are very different, but we do want to have some statewide metrics as well. And so really using that county process is the opportunity to have those discussions, to make those partnerships, to really pull folks together.

We really think that there's a lot of opportunity in terms of how we can really remove those silos and pull partners together. And then finally, I'll just speak about the accountability piece. In conjunction with these three year accountability plans, integrated plans, having counties report annually on a complete set of data in terms of their spending, the various funding sources, whether it's Med- Cal realignment BHSA, their block are what dollars they're using for services, what are in their reserves, what are unspent dollars?

Information with regard to utilization outcomes stratified by various demographic populations, whether it's BIPOC or LGBTQ. Trying to understand how those dollars are used and what are the outcomes we are receiving from those dollars. And so just closing with that and also recognizing some of the feedback we'd heard with regard to the Mental Health Services Act and so maintaining their independence as part of state government and really taking advantage of their expertise with regards to full service partnerships, early intervention and innovation and having them provide special technical assistance. And in the innovation front, really providing a list of ideas for all of those different buckets, housing, full service partnership, behavioral health services and supports. What are innovative ideas in each of those buckets instead of just in its own little bucket? How do we innovate across all of the local buckets in BHSA and having the OAC really lead the effort in terms of developing some technical assistance and best practices there. So with that I will conclude.

Thank you. Go ahead, Matt.

Thank you very much for having me, Matt Lege on behalf of SEIU California. And just first want to thank the committee for holding the hearing and the informational hearing to hear from everyone. And then also want to thank the author for her incredible work on this in the Administration, of course. So just here on behalf of SEIU California in support of SB 326, which will modernize the Mental Health Services Act.

SEIU represents a wide range of behavioral health service providers and professionals across county and community based organizations, from case worker, treatment counselors, social workers, peer navigators, to everything else in between. We are instrumental in the initial passing of Prop 63 and we're here to share some of the lessons we have learned around improving the act, but also to sound the alarm on the workforce crisis that we're currently in.

Workers are currently leaving the healthcare industry at a high rate, and our ability to deliver care is foundational to actually meeting the needs of our populations that we serve. And so, first and foremost, SEIU supports SB 326 because we believe in a holistic, compassionate approach to care with a focus on equity, and we believe this proposal makes that good start.

We must ensure consumers with severe or serious mental health illnesses and substance abuse disorders, or those who are at risk of those illnesses or disorders, have the quality care that they need, both physically and mentally, and we must provide with them. We provide them with the tools they need to live productive, independent lives. Second, we want to ensure that there's a pathway to quality job and quality services. And as I mentioned, we are really in a shortage of particularly of behavioral healthcare workers.

And we can only meet these care goals if we have a workforce to actually be able to deliver on the needs that the population demands. And that will only happen if we are improving our recruitment, our training, and retention of that workforce. This Bill importantly achieves some of these goals by providing that 3% as Director Baass mentioned of the annual BHSA funds to allow leveraging federal funds for a $2.4 billion workforce initiative through Behavioral Health Connect in the 1115 Waiver.

Addressing the workforce services will be critical to the success of the MHSA, and we strongly support these components of the proposal. Additionally, ensuring that frontline workers receive an increase in wages based on the incentives to help align the workforce with the goals of the local MHSA plans is critically important and there's really no magic wand to create experienced and trained healthcare workers.

A crisis of several decades in the making is going to take time and investment to overcome, and this level of sustained investment is critical to delivering on the care needs of our communities. Finally, accountability standards and reporting, and we believe that this proposal puts important measures in place to be able to hold ourselves accountable to delivering the care that our communities need.

Importantly, the county behavioral health outcomes, accountability and transparency measures will help provide both the public and behavioral health workforce more transparency into county spending with an eye towards results. We will have more information to be able to rectify any issues on pieces that are privatized so we can sure that we are not wasting taxpayer dollars.

This proposal also requires counties to report annual service utilization data and expenditures of state and federal behavioral health funds, unspent dollars and other information, and it authorizes DHCS to impose corrective action plans on counties that fail to meet these requirements.

The proposal additionally requires both local and state planning and oversight to ensure that workers have a voice at the table with county administrators, community based organization, health plans, and other stakeholders to better coordinate and streamline delivery of care and supports that will make a meaningful difference in the communities that we serve. Addressing California's behavioral health workforce crisis and behavioral health system is a complex and multifaceted problem and this proposal is an important step forward to modernizing California's behavioral health system.

The whole person approach, robust planning process, accountability of providers and investments in the workforce are critical to delivering on the care that every Californian is entitled to. For these reasons outlined, SEIU supports SB 326. Thank you very much.

Okay, thank you. Others in support. Excuse me. Hang on. We do have a quorum. Never mind. Please. You can go ahead and form a line there, but Madam Secretary, please call the roll.

Wood. Here. Waldron. Here. Aguiar-Curry. Here. Arambula. Here. Boerner. Here Wendy Carrillo. Here. Flora. Vince Fong. Maienschein. Here. McCarty. Here. Dixon. Rodriguez. Here. Santiago. Here. Villapudua. Weber. Here.

Okay, we do have a quorum. So just your name, organization if you represent one and, your support of the bill.

Kathy Van Osten on behalf of Big Brothers Big Sisters. We like the direction bill is going in and encourage more of a set aside for homeless youth.

Thank you. Just your name, position and organization if you represent one.

Thank you Mr. Chairman and members, Moira Top, on behalf of the Big City Mayors coalition of mayors of the 13 largest cities, all unanimously in support.

Thank you.

Good afternoon. Tara Gambo Eastman with the Steinberg Institute in support.

Thank you.

Good afternoon. Robert Harris on behalf of CSAM, the California Society of Addiction Medicine in support.

Thank you.

Good afternoon. Caroline Cirrincione, on behalf of the League of California Cities, in support.

Thank you.

Leah Barros, on behalf of California Hospital Association, in support.

Thank you.

Nico Molina on behalf of the Silicon Valley Leadership Group, in support. Thank you.

On behalf of the Greater Sacramento Urban League, in support.

Thank you.

Izzy Swindler on behalf of Mayor London Breed of San Francisco and the City and County of San Francisco, in support. Thank you.

Thank you.

Good afternoon. Ross Buckley, on behalf of Sacramento Mayor Darrell Steinberg. Thank you.

Good afternoon. Sharon Gonsalves, on behalf of Mayor Karen Goh at the City of Bakersfield and the City Council, as well as the City of Carlsbad, in support. Thank you.

Thank you.

Danny Curtin, California Conference of Carpenters, in support. Senator, thank you for seizing the moment.

Thank you.

Tom Renfrey on behalf of the California Association of Alcohol and Drug program executives, In support.

Thank you.

Thank you Mr. Chair and members. Doug Subers on behalf of the California Professional Firefighters, in support.

Thank you.

Good afternoon. Sherry Daley with the California Consortium of Addiction Programs and Professionals, in support. Thank you.

Thank you.

Good afternoon, chair and Members Mike West on behalf of the State Building and Construction Trades Council, in support. Thank you.

Thank you.

Good afternoon, Mr. Chair and members of the committee. Brandon Marchy with the California Medical Association, in support.

Thank you.

Max Perry, the City of Riverside. Also in support.

Thank you.

Richardson Davis from the California Council of Community Behavioral Health Agencies. We have a neutral position on the bill. Thank you.

Thank you.

Good afternoon. Sharon Report with the Corporation for Supportive Housing. We support in concept. We do have some concerns we're trying to work through with the Administration. Thank you.

Thank you. Thank you very much. Anyone else? No one is there. We have opposition to the bill, so I think we have two witnesses, I believe. This is...

Hi members, chair members. Josh Pane. One thing that is missing, and this is why I have to oppose the Senator's bill, is this concept that we won't have anywhere in between. Those folks on the street are not going to voluntarily come in, so we need an in between, a third way, Mr. Chairman. Mr. Chairman. And this is what...

Are you in opposition to the bill?

Yes.

Okay, thank you.

And so, Mr. Chairman, I'd like the committee just to focus on this concept. All the people that we see that I go out and visit on the street are not going to volunteer. My mom, when she was on the street, or my brother, they weren't going to volunteer. Nick Petra said it best in his oral biography, the P and the LPS. These folks, they don't know exactly what they're doing. They may not meet the criteria of 5150, but there's something in between.

So I just ask you all to look at the Probate Code. We already have a guardian ed lightem in the Probate code. We can use that to help people, to get them off the street, get them treatment. My mom never would come off the street. Ultimately, she needed to be conserved. My brother, finally, finally, because of his alcoholism and his drug use. So I'd urge you to look at the Probate Code. There's just three provisions in the Probate Code 1003, 320, and 1800, sequence past that.

These three provisions, Mr. Chairman and members, could help us get to those vast numbers of folks who won't volunteer. And all we're doing with this piece of legislation now is shuffling the chairs on the deck, 10,000 new beds, I appreciate, but we need a mechanism, a tool, a law to get these folks into that category. So I just urge you to simply look at a simple amendment on that code section. And here's the amendments. It's pretty simple.

But if we don't, and the voters pass this and the voters pass this, then, Mr. Chairman, we will be sitting here next year, perhaps me or someone else, and there won't be any hope for those folks out on the street. So I'd appreciate you all to just look at that from my mom, who's now died, but was on and off the street, from my brother who's now died. So if you could just look at that and look at a third way, we might have an attempt to do this just adjusting those three sections of the Probate Code. Thank you, Mr. Chairman and members. I appreciate it.

Thank you. Please, you're out of order. Please. Just so I see, there are two people here. Are you expecting to speak in opposition? Because we only have two witnesses and she was here first, so. Okay? So please, you have three minutes. You need to push the button on the mic there. Thank you.

Okay, that was a lot. All right. My name is Colette. I'm a peer. I'm opposed to SB 326. I want to say that ten years, ten years ago, I moved to California because of the Mental Health Services Act. I was someone who had a severe mental illness on the heels of a suicide attempt. My mother and I moved across the country because we heard about Prop 63, because I heard about peer support. The Mental Health Service Act has deeply impacted my life.

It gave me community, the traditional mental health services. Said I was ill, said I would never recover, said I would never have a life, said that I'd always be medicated, I'd never get married, I would never have a job. I stand here in front of you today because of peer support, because community based organizations saw me and we saw each other and we supported one another. I am someone who has recovered and recovery is possible.

What I'm really concerned about with this is that we are having the wrong conversation. That you are taking a conversation around what happens to people who are unhoused and their mental health challenges because they become unhoused versus what happens when someone needs support. We're saying, who is severely mental ill and who is not severely mental ill? We are a spectrum. We need a continuum of mental health services. We cannot rob from one pot to support the other pot or are we going to have upstream crisis?

We're in a youth mental health crisis. Our Black, Indigenous, people of color have been not coming to services for years. Not because of just stigma, because services have been traumatizing. Peer support, grassroots organizations and community defined evidence based practices have been instrumentally supportive. And all we've done is ask for evidence for Black and Brown people, for services for Black and Brown people, and given that evidence and not funded it.

So I stand here before you because I think and I believe we need to Fund housing through housing. We need affordable housing, absolutely, but we don't want to take away mental health services upstream, and then you'll have a different kind of crisis. I think the intention is good, but the consequences will be extremely, extremely grave. And not to mention our LGBTQ communities, which we didn't get to hear as much from today antitrans bills banning them.

We are in also another type of crisis for our folks, for our populations. And once you take away services, once you tell a county, oh, it's flexible, that means it's optional. We cannot have flexible populations. We are not flexible. We need allocated services for ourselves, for our community. SB 326 is not going to do that. And I think the intent is good, the impact is not there. We have to slow down.

We are moving so fast to get this passed in March so no one else sees that. Why? Where have communities been? We talked about Black and Brown people all day, and we only saw two on the last panel, right. We need to be at the table. Slow down. We don't have to rush huge decisions that are going to impact the entire state of California. I know that's not what you want. I know that's not what you want. So I urge you, I oppose SB 326. And I say please, please do not put it on the ballot for March. Thank you so much.

Thank you. Okay, so others in opposition can come to the microphone with just your name and your position and any organization that you represent.

Hello, my name is Mariana Sosa and I represent California Youth Connection. And we oppose Senate Bill 326.

Okay, thank you.

Priscilla Quiroz here on behalf of the California Academy of Child and Adolescent Psychiatry and on behalf of the Board of Supervisors of Kern County and Nevada County of Board of Supervisors, all have a concerned position. Thank you.

Okay, thank you.

Hello, Tiffany Elliott, representing Painted Brain, a nonprofit peer run organization located in Los Angeles. We oppose unless amended.

Thank you.

Hi, Darby Kernan, representing the First Five Association of California in opposition unless amended. Thank you.

Good afternoon, Amy Jenkins, on behalf of the Orange County Board of Supervisors with concerns thank you.

Thank you.

Stacie Hiramoto REMHDCO, the Racial and Ethnic Mental Health Disparities Coalition opposed unless amended.

Thank you.

Jenny Choislaw with California Coalition for Youth in opposition unless amended. Thank you.

Thank you.

Allison Monroe, Families Advocating for the Seriously Mentally Ill, oppose unless amended because it does not go enough...

Hello, Michael Fields from Peer Recovery Services in San Joaquin County. You're invited to come visit us at our wellness center. Thank you. Opposed.

Thank you.

Thank you, chair and Members Serette Kaminski with the Association of California School Administrators. Respectfully opposed unless amended.

Thank you.

Danny Thirakul, on behalf of the California Youth Empowerment Network and Mental Health America of California in strong opposition.

Thank you.

Good afternoon. Adrian Shelton with the California Alliance of Child and Family Services with the concerns position.

Okay, thank you.

Good afternoon, LaTanya Ri'Chard, Communities Voices co founder and Associate Director, and in light of the 60th anniversary of March on Washington, I revolutionarily oppose. Get at me.

Hi there. Rachel Bhagwat with ACLU California action at a concerns position. Thank you.

Thank you.

Jennifer Vanaman, Executive Director for Peers Envisioning and Engaging in Recovery Services in Alameda County and we vehemently oppose.

Thank you.

Paul Simmons with the Depression and Bipolar Support Alliance of California. I'd like to thank the chair for acknowledging that the opposition was co opted by a supporter. Thank you.

Kivi Feldniyami, a proud, queer Californian. I oppose strongly

Thank you.

John Lee, transforming U.S. care, we need integrated services, not separated services.

Thank you.

Hi, I'm Nicole Rosindo. I'm a program manager at Cal Voices, also a person with lived experience, and I oppose.

Jane Crystal from Santa Clara County, focused on a prayer movement bringing back positive community messaging instead of the crisis messaging.

Thank you.

Thelma Carver, Amador County, Cal Voices, I oppose.

Thank you.

Faith Cox, Amador County consumer of MHSA and I oppose.

Thank you.

Katrina Ozier, program manager at Sierra Wind Wellness and Recovery Center, a program of Cal Voices in Amador County. I strongly oppose.

Keith Pearsons with Sierra Wind Wellness and Recovery Center, Amador County, representing Cal Voices. And I strongly oppose thank you.

I'm Trixie Smith, Cal Voices, Sierra Wind Wellness and Recovery Center in Amador County, and I strongly oppose.

Lorraine Cottrell, consumer, Cal Voices, Sierra Wind, and I oppose.

Thank you.

Andrea Rivera, on behalf of the California Pan Ethnic Health Network, oppose unless amended.

Thank you, Avery Hulog-Vicente. On behalf of California Association of Mental Health Peer Run Organizations. Strong opposition.

Thank you.

Michelle Cabrera with the County Behavioral Health Directors Association of California with concerns.

Clare Cortright, policy Director with Cal Voices and former MHSA client, opposed.

Kelly Brooks, on behalf of the Urban Counties of California, we have a concerns position.

Sarah Dukett, on behalf of the Rural County Representatives of California with a position of concerns.

Thank you.

Good afternoon. My name is Krista Carpenter. I'm with Alameda County. Lift every voice and...and we oppose.

Thank you.

Stephanie Ramos, sibling of an FSP client, on behalf of the California Association of Peer Professionals we oppose.

Thank you.

Alexis Trejo, operation coordinator with Cal Voices and I oppose.

Thank you.

Nicole Wardelman, on behalf of the Children's Partnership, support if amended.

Thank you.

Cristopher Bunnell. San Joaquin Pride Center. Opposed unless amended.

Thank you.

Theresa Comstock with the California Coalition for Mental Health and the California Association of Local Behavioral Health Boards and commissions with a concerned position for both.

Hector Ramirez, Los Angeles County. Authentic stakeholder. Very concerned.

Leo Antolin, assistant for Calvoice's peer support specialist certification training, opposed.

Thank you.

Sarah Markshire, Alameda County family Member of an FSP client. Opposed.

Thank you. Anyone else? Okay, saying no and bring it back to the committee. Questions or comments for the author from the committee? I'm sorry, Ms. Boerner.

Yes. I want to commend the author for bringing this. Reforming our behavioral health system is not an easy thing, and you have been a champion ever since I entered the Legislature. I have a very specific concern, and one is the fact that in the informational hearing, we heard a lot about the diversion of mental health money to housing. And I understand housing first. I understand all that. So one, if you can speak to how that could be remedied going forward.

And the second question I have, as you know, I almost never vote for CEQA streamlining. And so I can see on existing buildings that are just being repurposed that you would have some CEQA streamlining because you're not going to be dealing with the underlying ground. But in my district, we often have nurseries with very heavily polluted from pesticides ground that has to be remediated, and that only comes out with the CEQA analysis.

And so I could see that there were concerns around that or paleontological, which sounds like an actual medical procedure, but I think I mispronounced the word. But that is my concern. So I generally don't vote for CEQA string landing. I'm sure you'll take a deep look at both of those things, and maybe if you have any comments, I will give you a courtesy aye today.

Thank you, very much and thank you for your dedication in this arena. And then, as you know, the bond will be for the construction of the housing, right? And the concept of this. And then of course, part of that will be able to use for interventions to pay for people while they're there that bridge housing. But the CEQA exemptions are for streamlining because in order for these villages and cottages to work, they need to be in and around communities that are already existing.

So they'll still have input because there still needs to be a big planning process to decide where to put them for multiple stakeholders. So while it's not an actual CEQA process, you'll have a lot of eyes on a project before it gets going. And again, the idea is not to put it out in somewhere that's going to have problems because you need folks to be close, close to transportation and all those things. And I'll see if the Director would like to add anything to that.

You've covered the piece of it. I was just going to comment a little bit on kind of the housing dollars and we've added some flexibilities in the language with regards to the local pots. So a few pieces. One, recognizing that some of our small rural counties may not have kind of the need for housing interventions just given their populations. And so we do have kind of an exemption process for small rural counties specifically, like considering their homeless count. And so trying to provide that flexibility there.

We've also added flexibility to move dollars between the three pots of local funding. So we have the housing, we have full service partnership and we have behavioral health services and supports. So we have added the flexibility in these recent amendments to move dollars between those pots, depending on the local planning process and local demonstrated need that starts at a move of a total from. So let's just use an example. 30% of housing of the local dollars are for housing.

If through the kind of the planning process it's determined that they may not need that full 30%, they can move 7% of total funds. So that would take it to 23% could be used for housing. And so we've established a kind of a process to really think through how those local dollars can move between the buckets depending on the local needs of the community.

I would just say that without CEQA, there's nothing that requires the remediation of the environmental impacts. And so that's my concern that while you can have lots of eyes on it, you don't have a way to legally remediate. And so that's my concern because it happens in my district every single time.

I think we had Dr. Weber first.

Good afternoon. Yes, it's definitely been a long day. I first want to thank our chair and committee for holding the hearing it was very informative and very much needed. This is a very significant issue. These are very significant issues that the state is facing. Behavioral health, homelessness. And we need to make sure that if we're going to do something, which is what we need to do, that we're doing it right.

We don't want to have to go back in a year, two years, three years, and realize that we rushed a process just to get something done. I want to thank the Senator for your work in this area. This is not your first Bill, it's not your first go around. This is something that you're definitely committed to. And I really want to thank you because it is a very complicated, very challenging these are very complicated and challenging issues. There are some very good aspects of this Bill.

I'm very much into the oversight, the accountability, the data, the research, using evidence based practices to help guide us to figure out what we should be continuing to do and what we should no longer be doing. Because clearly we have been doing some things that are working, but we have as a state, also been doing some things that are not working. I do, however, have significant concerns with this Bill.

I understand that a lot of people may have been talking for a long time about this, but I think for many, including those that would be most impacted, i.e. the patients, it does seem as if it has been rushed and that they have not necessarily been at the table when making some of these important decisions, including the counties as well.

And I think we can see that with some of these last minute amendments because we're hearing some of the suggestions from those who will be impacted or those that we are expecting to implement this. And so that is a concern to me because I want to make sure, like I said, if we're doing this, we're doing it right. And bringing those at the table who actually practice or are receiving care is critical. I'm very concerned about the funding. We talked about it earlier.

The current funding stream is very volatile. Looking forward to seeing what the recommendations are from the Governor and his team as far as that, but the reality is that we don't have enough funding as is currently. And now what we're asking with this Bill is for people to do more with, actually less. And so we need to fix our housing crisis, we need to fix our behavioral health.

But taking money from behavioral health to deal with our housing and homelessness crisis is not really the answer, I think, especially without increasing our pot of money. I'm very concerned about the impact on prevention on our pediatric population, and we discussed that earlier. We've also heard a lot about the fact that there's no provisions to target and eliminate the inequity in terms of outcomes based on race. There's nothing in here that talks about that.

And yet that is a significant issue when we talk about both homelessness and mental health and focusing on substance use disorders. When we've heard research today that those who have highest risk of mental health and homelessness are black and brown, have the lowest risk of substance use disorders when you're looking at the data. So there's a lot that needs to be hashed out in this Bill. I agree with my colleague from San Diego. Well, San Diego County. How about that?

We come from the same county. But elimination of CEQA is always of concern to me because we're now putting the most vulnerable in situations where they could be exposed to environmental toxins. When we do not do that for people who have a different socioeconomic status stand the fact that we want to get these projects done and that CEQA is oftentimes an obstacle. And so that's why I like certain streamlining.

But the elimination makes me really concerned about the environmental impact of where these houses or will be built. And so we do need a holistic approach by expanding our pot, expanding our resources, not trying to utilize the same pot, but asking people to do more.

Because at the end of the day, I think we will come out and see the data will show that we have not done all that we can and we may have failed in certain areas that we have the opportunity to do much better than I know you. I trust you. I know where your heart is. I will give you the courtesy vote today.

But my vote today does not necessarily mean that I will vote for this if it hits the floor, because I think that you've heard some of the voices today and there's some work that needs to be done. So I'm looking forward to seeing what you will do with the things that you have heard to see what the final Bill will be. Thank you.

Thank you very much, Assembly Member.

Thank you, Ms. Dixon.

Thank you, Chairman Wood, for allowing me to participate today and to offer some initial comments. I have been communicating regularly with Orange County Supervisor Katrina Foley and the county's lobbying team and you've heard from them today and who also the board was here in Sacramento last week to share their concerns. And I've heard that word a lot today. Concerns about the impacts any changes to the Mental Health Act will have on providing critical care services to at risk populations.

I want to thank the Senator for taking on this noble cause, this huge undertaking. And clearly, by listening to the comments and the informational hearing today, it's a very complex undertaking. So just to echo some of the thoughts and comments that have been making and I want to acknowledge the role Orange County has played or their performance has been a leader in how they have implemented their current funding, the MHSA funding to tailor programs that meet the unique needs of the county.

In fact, Sacramento Mayor Steinberg recently was quoted on the Sacramento Bee applauding Orange County as the only county meeting the required standard of the act and saw a 17% drop in people experiencing homelessness from 2019 to 2022, even while the statewide homeless rate went up. And so the success is not a coincidence. And this is the county's key point. What they're doing seems to be working.

And Orange County has historically supported legislative efforts to modernize MHSA funding, including sponsoring legislation to expand MHSA innovation funds to better meet the mental health needs of persons in custody. And while the August 15 amendments to this Bill are a step in the right direction, there are still concerns that need to be addressed as the legislation moves forward. And just in the interest in time, I'll just focus on one.

The current versions of the Bill still results in significantly less funding for core services in Orange County. Shifting 30% of MHSA revenue away from mental health services will reduce funding available for the existing core mental health services that are currently being provided. And you've heard some of the people reference that today. Specialty outpatient services, in home crisis services, peer and family support and outreach and engagement. And this reduction is by approximately $131,000,000 annually.

And in terms of suggested amendments, supervisor Foley and the county's lobbying team have provided me with the following, which the Board of Supervisors this morning approved earlier today. Instead of specifying rigid program category percentage requirements, provide more flexibility. We've heard a lot of that word, flexibility within the funding categories. Instead of rigid percentages by establishing targeted percentage ranges or minimum percentage floors, or allow Fund transfers between program categories to allow the counties to respond to economic fluctuations and better meet local needs and priorities.

Number two, to remove the strict subcategory percentage requirements to allow counties to provide consistent, stable funding for programs and successfully meet the unique needs of their communities. Number three, provide time phase in for transition to the new category requirements, the revised planning process and enhanced reporting requirements, which will require additional staffing training, technical assistance and system changes. And finally, increase the flexibility for capital funding for the housing to support associated infrastructure needs. So, bottom line, you've heard this a lot today.

Flexibility, the rigidity in the bucket, allocation of fundings perhaps does need to be worked on. So I appreciate your consideration on behalf of Orange County to their concerns and so their concerns are still concerns, and I'll be expressing that in my vote today. Thank you so much.

Thank you. Anyone else? Dr. Arambula?

Thank you. I'm going to begin. Dr. Eggman, I really appreciate your work in this space and your commitments to improve mental health for the state of California. This is not easy work, but you lean in and I believe you're meeting the moment. It's difficult to be able to have these types of conversations that are so necessary for us as a state to move policy forward. I will share some areas of concern that I hope we can make some improvements as this Bill moves forward.

As I believe your comment was that this Bill has us focus more but I question sometimes whether we need even more intentionality for us to address the children's and youth mental health crisis that we're having means we have to focus some of those dollars towards them. So I appreciate the movement you've made within PEI Whether it's gone far enough for many is a secondary question. But I want us to actually really dig in on the housing and FSPs specifically.

We've seen tremendous success when we've done youth set asides within HAP and homekey to address children's homelessness as a state that I question whether we should similarly be looking towards set asides within these housing dollars to continue that. Success as well as when we look at what we've seen within FSPs for the last five years and who's enrolling. 67% of them are children or transitional age youth. And I question why we haven't put similar percentages to insist that FSP Dollars are focused on those upstream.

So we can help to prevent many of the disease processes from ever really manifesting and perpetuating this homelessness crisis. So I'm hoping you can comment a little bit on those two issues and whether or not there's some latitude to be able to have these conversations. I understand there are sponsors and others in this room but have heard loud and clear from any of the children and adolescent advocates about the importance of having real intentionality in this space.

Yeah thank you Assembly Member and thank you for your work in this area especially the work that you've done around the budget has just been we couldn't be here without the work that you've done.

Yeah, I think we are still open and absolutely I was just very proud to be at Operation Home key for transitional age youth in an old hotel, motel six, right on the freeway which probably wouldn't have passed many CEQA things but you're getting a bunch of kids who are coming out of foster care the help that they need and in building that we had a lot of people coming up and saying no, not in my neighborhood.

So all of these things are incredibly complicated to meet this moment and is there room to do more for know as a mother, of course there's room to do more for I mean, I think we've heard a lot today.

We have made adjustments in the flexibility, added more intentionality as people have talked about and really tried, as I'll use the words of Michelle Baass, braid and blend all these different streams that we've been trying to focus on the work we've done in the last couple of years around the youth and behavioral health infrastructure while a lot of that was one time. Don't forget, the partnership between being able to Bill while at schools is really that's going to be ongoing.

And again, we think with a lot of these other investments we've made and changes we've made, a lot of those things. I mean, people are used to this being the one pot, right? There's a lot of different streams going in now. And I'm really grateful, especially to the chair and to this committee for really pushing back on earlier.

I don't think the oversight and accountability was front and center enough and through everybody's work, we've been able to bring that in more and make them in charge of looking at all the money. That was one of the complaints that we had before. They were just looking at MHSA and unable to see all the other inputs to do a good analysis.

So those things will be ongoing and yes, we will take back, I think, and look more deeply at intentionality around kids and to Assembly Member Weber's point about how are we actually measuring equity in the ways that we intend to, because this is meant to focus more on those who need it most.

I'll just piggyback, if I can, on the MHSOAC. I appreciate again, we're moving in the right direction. I don't think we've gone far enough to maintain their independence. Many of us value the LAO and the work that they do to provide us information. And I believe similarly, the MHSOAC needs their independence to continue to provide meaningful input for those of us here on the dais. With that, I thank you.

And thank you, Ms. Aguiar-Curry.

Thank you Senator, for bringing this forward. First of all, thanks for having a brass backbone because this is a tough one and we all know that as we sit here and trying to make our own decisions. The thing I really appreciate you guys took some look at our smaller counties and try to figure out what we're going to do because that's where my fear is.

Obviously it's my district and I think there's still some work to do there and I'm hoping that in the next couple of weeks, maybe with some of the input that we heard from today, from our audience and presenters, that we might take another look at how can we make it better? I did hear one group that didn't get too much voice today was our people with disabilities and we didn't have too much of a conversation.

Is there a voice at the table as well as some representative for them? I'm sure there are, but we didn't hear that today. So, again, I really admire the work you're doing. I look forward to continuing. I will again do what my others we'd like to have you move this thing along and let's see if we can make some more improvements as you do that. And so thank you very much for doing that.

Thank you for all your support and also always being a voice for the rural counties.

Thank you. Vice Chair Waldron.

Thank you. I didn't realize I was next. Thank you also, Senator, for your work through the years on this. I know you've been a very vocal advocate for mental health and helping so many people that are needy out there. We know how our system currently is. People get picked up, they get sent to the emergency room. They sit there, maybe they get treated, maybe they don't. They end up back on the street. And we've seen it growing and growing.

This cycle of need that is not getting addressed. I kind of ditto the remarks of all my colleagues up here about the fact that this is a great start and there's going to be more conversations, there's going to be more suggestions. There's definitely a lot needed as we move a big Bill like this. So I agree with the comments that were made, but it's critical that we remove the existing barrier to support and access, which is the substance use treatment part.

Getting people who have that need to this system is going to be major. Allowing people with co occurring disorders to enter treatment more easily as well as the justice involved, those somehow, when they're in the criminal justice system, get separated out and they're arguably some of the people that need it the most. So the current reality is we need accountability of where these funds are being spent. We need outcomes. We need to know the successes, and we also need to know the failures.

And I feel like we've all been talking about how money has been spent. We're not sure exactly where it's gone. We can see the results, which are not where we want them to be. So we want to know what equity measurements there can be that it's data driven as well as having the critical prevention opportunities. That prevention part we talked about at length earlier for our young people can't be stressed enough. So it's really important that we continue to focus on that.

I know there will be amendments that will be addressed in the housing committee, and I am very happy to support your Bill today.

Thank you.

Thank you. Anyone else? See, no one will bring it okay. See? No one. Guess it brings it back to me. First of all, Housekeeping, we have amendments before you or you're accepting our amendments.

Thank you. I appreciate that. Before I get too far into this, I want to build a moment of personal privilege here because I want to thank our team for the efforts that they have done on this in particular. Sitting beside me here, Judy Babcock. Not here with us right now, Lisa Morovsky. My entire team, our chief consultant, Roz Pullman, have really taken they've really literally rolled up their sleeves for weeks to try to work through this. And I recognize that look. Nothing's perfect.

And we heard input today here that may reflect on how we go forward here. Final little personal point of privilege before I go into a couple brief comments. Is today is the last hearing. We will have our chief consultant, Roz Pulmana, with us. Roz has been with the committee. I've been here eight years now, and she's been with us every step of the way. Roz is going to be the health policy consultant for Speaker Rebus, so she won't be thank everybody.

We could thank Roz Palmano for her work here. Oh, and I'm sorry, and I did not realize this gino is this is going to be your last well, we're not going to I guarantee you we'll have another health committee hearing. There will be another health committee hearing before this year is out because that's the way the process is. So I'll thank the rest of the committee then. But we will not see Roz at this dais again unless she comes back in some other role.

Who knows when. But anyway, so thank you very much for everything, Ross. Really appreciate it. So we've heard a lot today, obviously, and I think you need to bear in mind MHSA has been a really critical component in how we look at mental health in California. The author. The proponent for MHSA is Mayor Steinberg. Mayor Steinberg is in support of SB 326. And that is a really, really important piece of this puzzle. We're 20 years now, almost 20 years into MHSA.

And 20 years ago, the mental health situation was very, very different. It is important for us to modernize, to reflect the times that we live in now and to move forward. And I think that it is time. It is absolutely time. So of importance to me is a variety of things, but one is oversight. And so I want to thank the Administration. I want to thank you, Senator Egman, for working with us on this.

One of the things important to me was that we have a way to look back at what we're doing sooner than 20 years. And so one of the amendments that you're accepting is that we're looking that the California State Auditor, no later than December 31, 2029, issue a comprehensive audit on the progress and effectiveness of the BHSA, and there will be subsequent audits as well. And the audits are not meant to be a gotcha.

The audits are meant to be a check in to assess those things that are going really well and to build upon them and adjust those things that may not be going as well. So I think people get freaked out when they see audits. And you only need to fear an audit because you're doing something wrong and we're going to figure it out. But that is not the reason we're asking for the oversight.

It is the opportunity for the Legislature, the Administration, the Future Administration, to adjust as we move forward, to be even more effective in. The future. So I want to thank I know that's always a sticky one, but I want to thank the author and the Administration for that. Another thing that is kind of important, we've talked a lot about that is the flexibility. And I really appreciate that.

As the other person who represents rural communities or one of the other there's a lot of us who do I think that is really important going forward. And then one of the things that will continue to be addressed, I believe, from Dr. Golly's comments, is around the volatility of the so anyway, so that will be going forward. So with that, the Bill does enjoy a Due pass recommendation should it pass out. I'd like to be considered as a co author, if you'd have me, of course.

And with that, would you like to close?

Thank you very much. And thank you for the conversation. And thanks for the conversation you've been having all day. Right?

I mean, talk about rolling up your sleeves and really getting to it. But again, we have this time to meet this moment. And I will also add that while we're making this massive change and I was around when we were implementing means I'm old and I've been doing this a long time, but I remember the fears at that time, right? Because change is always hard.

People get comfortable in doing things how we've done it, and when we did this new implementation because we had to integrate it into our division of social work. And a lot of people got their MSWs. And I know Dr. Leandra Clark, maybe she said she got her psychology, she's a psychologist because of the MHSA money. I mean, that's the kind of impact that it can have. But there was fears at that time, too, that we were changing something.

Change is always hard, but this big change of structure is just the big outline of it, right? You'll all will be here. As you've all been here, there has been multiple bills that have come before you on our current MHSA to make adjustments. And that's what you'll be able to do going forward, right? So what we're doing is setting up the parameters, but there'll always be adjustments that are able to be made. So we are moving in a very positive direction. We appreciate, all of us.

And again, to remember, this is the entire continuum of care, and now we're just adjusting this part of it. It makes it uncomfortable, I realize that, but it's necessary. And so with that, I respectfully ask for your aye vote on this Bill.

Thank you very much. Senator Eggman. Do we have a motion? Was that Ms. Aguiar-Curry? So we have a motion by Ms. Aguiar-Curry, a second by Vice Chair Waldron. The motion is due pass to Housing. Madam Secretary, please call the roll.

Wood aye. Waldron aye. Aguiar-Curry. aye. Arambula aye. Burner aye. Wendy Carrillo aye. Flora. Vince Fong not voting. Mainshine aye. McCarty aye. Dixon not voting. Rodriguez aye. Santiago aye. Villapudua not voting. Weber aye.

You have eleven votes that Bill is out.

Thank you.

Thank you very much. We have one Member who has not voted, so hope that he's not going to make it today. Okay, so the final vote for this Bill is eleven to zero. With that, this meeting is adjourned.