Assembly Budget Subcommittee No. 1 on Health

All right, I'm going to call this hearing to order. And thank you so much for your patience. And we're going to Committee staff, if you could please call the roll.

[Roll Call]

Well, good afternoon and welcome to Assembly Budget Subcommitee Number One on Health, covering the state's investments and fiscal policies on behavioral health. I am going to take a point of personal privilege to make a few comments about the last happenings of the last couple weeks as they pertain to health care before we launch into the hearing.

And so I did want to touch on, you know, just 22 weeks ago, on March 24, without any advanced warning or notice, the federal Administration unilaterally eliminated $11 billion in funding that had been supporting critical public health work across the country. And from early estimates, California stood to lose nearly $840 million.

And the reason that I bring this up is that we've talked a lot about our concern as a Committee. Our concern are bound to any to health care at the federal level. Of those cuts that happened, 330 million was cut that would have directly supported public health efforts at the local level.

While this funding was originally awarded during the COVID 19 pandemic, it had been repurposed with prior agreement from the Federal Government to support public health infrastructure. What this looks like in real life, in real time, was cuts to immunization clinics, cuts to health screenings, referrals to other health and social services.

It also looked like cuts to public health laboratories and data systems that tracked and respond not just to COVID 19, but to influenza, RSB and other infectious diseases. That was cuts to medical supplies, including syringes, needles, swabs, Ppe, anti and refrigeration equipment.

But it was also cuts to staff positions affecting real people and real people's jobs, such as laboratory staff, microbiologists, epidemiologists, disease investigators, infection prevention nurses and immunization teams.

And while the federal Administration has attempted to justify these cuts with arguments that the funds were only ever temporary, what we know is that the funding was not expected to expire until at least next year. And so this sent our public health into complete shock. This continues.

This happens as we are all reeling from the aftershocks of tariffs. And these cuts are another example of a Federal Government that is governing through unpredictability and causing a lot of concern in the healthcare world.

In addition to that which happened a couple weeks ago, the Federal Government also eliminated $120 million in funding for mental health and substance use disorder initiatives, efforts designed to reduce overdose deaths and expand access to life saving medications for opioid use disorder.

But as if that wasn't enough of an attack on California's health care system, the Administration, the Federal Administration also suspended millions of dollars in Title 10 family planning grants. And that is funding that is provided for health care services such as birth control, cancer screening and STI testing for individuals from Low income households.

And California's Title 10 network is the largest in the country with 50 healthcare organizations and 360 health centers serving over half a million patients last year. I will say on Saturday I was with somebody who works for Planned Parenthood on the Central coast and their affiliate abruptly lost $390,000 overnight, impacting their ability to serve patients across the Central Coast, a rural area where there's already very little health care.

We know that the threats are very, very real when it comes to health care. And I do want to thank our Attorney General Bonta for taking swift legal action against these reckless actions.

And I also want to thank Assemblymember Bonta, chair of the Assembly Health Committee, who took time on the floor last week in honor of Public Health Week. And we were able to celebrate the real heroes in public health last week, knowing what a challenge they are facing at this time.

And I want to take a moment to express my deep gratitude to essential public health workers for their commitment to keeping our communities safe from those who responded to the LA fires, to those who are working on the Moss Landing Battery fire in my own district, to many who are carrying out critical public health work across our, across our great state, including containing and responding to the Avian flu virus.

So this Committee is also committed, as I've stated numerous times, to doing our part to holding hearings that examine the State of health in California and what we need to do on a budget level, but also to be really astute and cognizant of how much what is happening at the federal level affects in California right now.

And so I'm going to pause there and invite any of my colleagues who wish to make opening remarks if they want to. You're welcome to Assemblymember Schiavo.

Thank you, Chair Addis. And I just want to join you in raising, you know, serious concerns around the funding that was cut to Title 10. We know that approximately 85% of the household's income is less than 150% of poverty.

So Title 10 network includes county departments of health, federally qualified health centers, urban Indian health centers, University and hospital clinics, planned parenthood affiliates standalone women's health and family planning providers.

And while state programs such as Medi Cal and Family Pact reimburse for clinical care providers provided by some Members of the health care team for income eligible patients, Title 10 funds are leveraged for non reimbursable health services provided, community outreach and education, youth programs and wraparound services to fill the gaps in family planning and safety net.

This is an unprecedented and arbitrary and immediate pause in the distribution of critical resources that's harmful, harmful to patients and providers. I myself relied on clinics like these when I got out of school and was only making $35,000 a year supporting me and my husband who was in grad school.

And so I know how critical these are for basic health care that people need and cannot often afford elsewhere. So we hear a lot of rhetoric from, from this Administration about local control, about that states should be able to decide. And yet all of these dollars that we send as a state to the Federal Government are being stopped from coming back to us.

So at the end of the day, taxpayers in California are being robbed of what they have invested to really take care of people in California themselves, their neighbors, and expect that these contributions that we make to the Federal Government will come back to us. We know we already give to other states to support them.

We should at least get back to us what is due. And so any funding delay is detrimental and the extended delay would have devastating effects on, on the health of communities across California. Reducing critical care for people who already face significant barriers to time sensitive healthcare services, threatening overall well being and economic security.

And as a state, we know that we must do everything that we can to maintain and Support California's Title 10 provider network and access to essential family planning services and outreach and education and activities like that that link community Members to care, including backfilling.

The loss of the title 10 Federal Family Planning funds, that's what we will continue to do. But you know, we know the more that they take it out of state's control, the state's ability to decide for ourselves what we want, how we want to invest in health care, or that they're taking things that we rely on federal funds for so that the state can decide how to use our own funds in other areas where is needed.

They continue to tie our hands behind our back to provide the kind of care and health care that people in our community need. This is hurting Californians, it's hurting people who are struggling the most.

It's the worst way to approach healthcare and it's unconscionable and unfortunately, I don't think that this is the last of these kinds of unconscionable decisions that we're going to be seeing when it comes to health care and the Federal Government. But, you know, California is going to continue to do everything we can to be a backstop against that.

Thank you. Any other comments before we get started with the hearing? All right. Well, with that, just a few housekeeping notes.

Today's hearing is going to focus on California's investments and fiscal policies related to behavioral health, which includes the budget for the Department of State Hospitals, infrastructure bond funding approved by California voters under Proposition 1, the Children and Youth Behavioral Health Initiative, the Medi Cal BH Connect waiver, and updates from the Commission for Behavioral Health.

And we'll cover six issues as listed on your agenda. The agenda is available online and on our, excuse me, online on our Committee's website, and physical copies are available here in the hearing room.

After we conclude a panel presentation on each issue, we'll take questions from the Members, then comments from the public, and all public comments will be taken in person at the end of each each issue.

We do ask that your comments pertain to the specific panel and we will open up for public comment for items not on the agenda at the very end of the hearing. And so we do ask that you keep your comments to one minute.

We've been very, very generous with time for public comment and would like to be able to hear everybody's voice. And so if you can be respectful of one another in that nature.

If you are unable to attend the hearing in person, you may also submit your comments via email to asmbudget.gov and we will start with our first issue with the Department of State Hospitals Budget overview, budget change proposals and trailer Bill. Background for this item will be on page two of the agenda.

And and for this panel, we are welcoming State Hospital Director Stephanie Clendenin, the Department of Finance and the Legislative Analyst's Office. And on this issue, we're asking the Department to provide three things, an overview of the 25-26 state hospital budget, a summary of budget change proposals and trailer Bill, as well as an update on the incompetent to stand trial population as well as workforce development.

And if you could each limit your if you could limit your testimony to six minutes and go ahead and introduce yourself and start whenever you are ready.

Good afternoon, Chair and Member Stephanie Clendenin, Director for the Department of State Hospitals. The Department of State Hospitals provides evaluation and treatment for individuals with complex behavioral health needs across its continuum of care which includes the five state hospitals in various community, inpatient, outpatient and jail based settings across the state.

The 25-26 Governor's Budget proposes a total budget of 3.4 billion for the Department which is an increase of 3.4 million from the 2024 Budget act which includes both the support and capital outlay and proposes 38 new positions. The proposed budget will allow the Department to maintain operations, delivery of services and provide for state hospital facility capital improvements.

At the end of the 25-26 fiscal year, DSH projects a total patient census of 8,527 patients, an increase of over 204 patients from what is projected at the end of current year. For our caseload estimates we have three that we to cover the patient driven operating expenses and equipment.

We're requesting 21.7 million in fiscal year 25-26 and and ongoing tied to increased patient service costs in census and the primary increase cost drivers include utilities, pharmaceuticals, foodstuff and outside hospitalization costs for Coleman. Increased Referrals we're requesting three positions in budget year and ongoing.

This is position authority only to address increased workload related to referral intake for Coleman patients which are current California Department of Corrections and Rehabilitation incarcerated persons who are referred to DSH for inpatient treatment.

DSH and CDCR recently implemented new trial processes with the goal of increasing referrals and utilization of DSH beds and the physicians requested will assist in managing the referral intake workload associated with these new processes. For incompetent to stand trial solutions, we're requesting 23 positions. Excuse me, Position authority only and budget year and ongoing.

My apologies, I got a crackle here. One of the positions will support data collection and outcomes monitoring for the diversion program and the remaining 22 positions are to support the Reevaluation Services program on an ongoing basis. Reevaluation Services was originally funded as a four year program.

In authorizing the program on an ongoing basis, DSH will be able to continue to provide reevaluation services for IST defendants in jail as well as to strategically deploy forensic evaluators resources to support the community IST treatment programs that do not have forensic evaluator capacity Capacity.

The Department is also reporting a one time savings in IST Solutions of 237.5 million in fiscal year 24-25, 82.1 million in 25-26 and 78.9 million in 26-27. We have one BCP. This is for statewide project management.

We're proposing position authority for 12 positions in fiscal year 25-26 and ongoing and this is to address the sustained increase in workload in the number of design and construction projects. This request is for civil service position authority only and is cost neutral.

The request the proposed positions will replace contracted project managers and transition the contract expenditures to personnel services and then for capital outlay for the we have a Napa electrical infrastructure upgrade project which is a mouthful. DSH proposes 2.8 million in General Fund for the preliminary plans phase.

This this project is necessary to meet the electrical demands of the facility and will upgrade the electrical distribution infrastructure which includes replacement of the existing transformer, substation, utility feeder lines, facility transformers, switch gear, and installation of an additional generator for the update on the IST population Over the past decade, the Department experienced significant growth in the number of individuals who were found IST on felony charges and referred for competency restoration, with the growth in referrals outpacing the Department's ability to create sufficient additional capacity.

Until recently, despite DSH's efforts to expand treatment capacity, the growing rate of IST referrals resulted in an ongoing wait list for individuals needing competency restoration. Additionally, as a result of COVID 19 impacts and necessary infection control measures that we had to implement at the state hospitals, the waitlist and wait times increased significantly.

As a result of a 2015 lawsuit by ACLU regarding IST dependents that were waiting in jail to be transferred to DSH's treatment programs, the court ordered the Department to initiate substantive treatment services within 28 days. The court set a deadline and interim benchmarks for DSH to meet the 28 days and these were subsequently admitted.

Due to the COVID 19 pandemic, the current deadline for DSH to achieve 28 days was by March 1st of 2025. The 2022 Budget act included a significant investment towards additional IST solutions that were informed by a statewide workgroup of IST stakeholders convened in 2021.

These solutions, along with other prior approved investments, include short and long term strategies centered around two primary goals. They were initiating treatment services for ist individuals within 28 days as required by the court and increasing community based treatment and diversion options with the goal of reducing criminalization of individuals with serious mental illness.

As a result of the rapid implementation of the IST solutions and the easing of the pandemic impacts and other DSH efforts, we have seen substantial decreases in both the IST waitlist and wait times. During the pandemic.

In January 2022, we reached an all time high of 1,953 IST individuals on the wait list and individuals were averaging wait times of over 140 days. As of the end of February 2025, we had only 281 individuals on the wait list.

281 represents less than one month of referrals as the average this fiscal year, we received 469 referrals per month.

Department recently submitted its final report to the Court on its progress in meeting the deadline of March 1, 2025 to provide the substantive services within 28 days, and the report reflected that the average time to initiating treatment for ISTs in February 2025 was just five days and since November 2024. 100% of all ISTs who did not have extenuating circumstances beyond DSH's control received services within the final court compliance benchmark of 28 days.

I'm going to hand it over to Chief Deputy Director Brent Houser to direct address the workforce update.

Good afternoon Chair Members. My name is Brent Houser, Chief Deputy Director of Operations for the Department of State Hospitals, and I'll speak briefly to the workforce updates as it relates to today's hearing agenda. By way of background recruitment and retention have historically been challenging for the Department of State Hospitals and was only exacerbated during the pandemic.

While DSH is not alone in its staff staffing challenges for Healthcare Workforce we do present some unique challenges due to multiple factors, the individuals DSH serve has some of the most difficult to treat behavioral health challenges, somewhat significant violence risk levels.

This coupled with the geographic location of our facilities, in addition to nation nationwide shortages of healthcare workforce do make recruitment and retention very challenging.

Due to these factors, the Department has implemented a multifaceted approach to addressing these challenges across four domains, the first being marketing and outreach, second streamlining the hiring process three Developing, expanding, developing and expanding training programs and four employee compensation.

We have made great strides in some disciplines and some locations, however continue to be challenged regionally across some facilities and some classifications. While certainly not a comprehensive list of strategies before you today wanted to provide a brief summary on the Department's efforts.

We have expanded our psychiatric training programs to develop a pipeline for employment with the Department that includes the expansion of DSH Napa's residency program from 7 slots to 10 slots with its first cohort completed this year. We are creating a residency program at DSH Patton and partnership with Loma Linda University.

We have executed numerous fellowship programs across the system with UCLA, UCSF, Stanford and Riverside, and we also have expanded rotation partnerships with Kaiser and Community Memorial Health. On the marketing and outreach front, we have contracted with a firm to create specific marketing and outreach campaigns for hard to recruit and fill positions to increase the number of applicants.

In partnership with the psychiatric technician program directors across the state, we have worked to develop an online platform to better align our employment recruitment efforts with with the educational program recruitment efforts so that it's a one stop shop for individuals to know how to become a psychiatric technician.

In California, we've hosted multiple virtual and career fairs on site as well as instituted rapid hiring events. So we're able to provide on the same day contingent job offers to really streamline the process and make it easier for individuals.

And last but not least, while DSH is not the primary or the decision maker as it relates to collective bargaining, we do inform the process and participate with CalHR, which has led to employee compensation increases over the past few years, whether that be paid differentials, retention bonuses or General salary increases.

That concludes the Department's testimony on issue number one. We're happy to take any questions. Thank you.

Anything from DOF or LAO? Okay, I just have a couple of questions on incompetent to stand trial. One, you've made tremendous growth on the wait time. Do you see the trend sort of leveling off on referrals, continuing to grow? What are your projections and how are you handling that if it continues the way it has been?

Yeah, well, the referrals had been increasing year over year. We have experienced a decline in referrals since the implementation of SB 1323, which implemented on January 1st this year. SB 1323 prioritizes community treatment for individuals who are incompetent to stand trial on felony charges rather than committing them to dsch.

When the court finds that it is in the interest of justice, when it's not in the interest of justice to restore the individual to competency. SB 1323 requires, when it isn't in the interest of justice to restore the person to competency, that the court consider diversion options.

If the individual isn't eligible for diversion, then the court may consider other options such as conservatorship, care court or assisted outpatient treatment. So it's really too early to tell ultimately what the long term impacts are and we're going to continue to monitor and adjust as needed. But should it not continue to reduce the ist?

Solutions were designed to meet the level of referrals and that we were anticipating before SB 1323 had been implemented.

Thank you. And then I appreciate that. And we'd be interested to see I heard you say it's too early to tell. So interested in a report back on that and then on workforce development. I represent one of the state hospitals and also an area that has very high cost of living. It's hard to recruit people there.

I've always heard state. State hospitals are sort of provide good jobs, so to speak, and so just kind of interested on lessons learned. I hear you have a four pronged approach and there's a lot of good things in place. But what you're seeing that's truly working and where we need to put more emphasis.

I think the most effective approach we've experienced over the years is really around the training and development programs. Really growing our own. We've found an extra experience. If we're able to bring individuals in for the training, they generally would like to stay with us.

Not everyone, of course, and that still benefits California more broadly, but we do that in a variety of ways.

I spoke to a little bit about the partnerships with community, Community Memorial Health, which I believe is in the central coast region, as well as other educational institutions to really provide them a training site and engage them early so that they can stay with us as been very effective.

Also expanding a program called the 2020 program, which allows entry level staff Members to work full, excuse me, work part time, but get paid full time. And the other halftime they're spending getting their RN or a psychiatric technician license. So they stay with us.

So I think really engaging folks early, whether it's in a license classification to begin with or not. We're really investing in those individuals so they stay with us.

Thank you for that. Any other questions from the Committee? All right, well, okay, thank you. We'll open up then to public comment. If you can make sure that your comments are directed towards the Department of State hospitals. Please keep your public comment under 1 minute.

If you're speaking on a previously stated position, then you can please provide your name, organization and position only.

Good afternoon, Members of the Subcommitee. Diana Luna with California Behavioral Health Directors Association, which represents the 58 county directors. I wanted to provide a comment on the county IST growth cap.

Given the recent initiatives that have an overall effect of increasing the numbers of individuals that are deemed ist with a charged felony, such such as Proposition 36, we wanted to urge consideration of revisiting the methodology used to calculate county ISD growth caps. As we anticipate that these initiatives will potentially result in counties exceeding their IST growth cap. Thank you.

Seeing no other Seeing no other public comment, we will move to issue two, overview of Proposition one. The background for this item is on page 10 of the agenda and the LAO has provided a supplemental handout also available at the entrance to the hearing room.

This panel is informational and is meant to help frame the next few issues that are on the agenda for this panel. We are asking the LAO to provide an overview of Proposition 1 passed by the voters in March of 2024. And this will include three main things.

How Prop 1 changed county funding allocations, changes to the Commission for Behavioral Health, and background on the Behavioral Health Continuum Infrastructure Program and its bond equivalent approved under Proposition 1. So we welcome Will Owens from the Legislative Analyst Office as well as represent from the Department of Healthcare Services and the Department of Finance.

And you each have about five minutes, so please go ahead and introduce yourself and start when you're ready. Thank you.

Yes, hello, my name is Will Owens with the Legislative Analyst Office. So we've been asked to present an overview of certain portions of Proposition 1. And today I'll be speaking from our handout titled Overview of Proposition 1 An Assessment of Behavioral Health Continuum Infrastructure Program.

So your agenda lays out a number of the major changes made by the Proposition. Today, though I'll be discussing the key components of the measure as they relate to other items in the agenda, namely the changes to the Oversight and Accountability Commission as well as the bond.

So first on page start off on page two of the handout. It's also a table located on page 12 of your agenda. So following the approval of Proposition 63 in 2004, counties received funding from a 1% tax on incomes over $1.0 million, known as the millionaires tax.

So part of the Proposition also set out categories of funding that counties were required to spend the millionaires tax revenue on, also known as buckets of funding. So as I said, on page two you'll see a table that lays out these buckets both under Proposition 63 as well as Proposition 1.

I'll point out two buckets in particular under Proposition 63. First, the Prevention Early Intervention bucket, as well as the Innovation Program bucket, both of which the Commission has had a role in overseeing. Following voter approval of Proposition 1, these buckets were revised.

The bucket for innovative programs was removed, and prevention activities are now the responsibility for the Department of Public Health. And lastly, early intervention is a required subcomponent of the Behavioral Health Services and Supports bucket.

So on page three of the handout we go over some of the major changes to the Oversight and Accountability Commission the Commission will be presenting on a later item and then I'm sure they will detail a little bit more.

But just to kind of give you a brief overview, first, one of the major changes was the structure of the Commission itself changed. Under Proposition 63, there were 16 voting Members. Now under Proposition 1, there are 27 voting Members.

The additional Members are all appointed by the Governor and make up a number of additional representatives from individuals or family Members, the public, as well as individuals representing different advocacy organizations. Second, the Commission had previously had a rulemaking and priority setting role and responsibility regarding the prevention early intervention bucket.

With this bucket being removed under Proposition 1, Department of Healthcare Services DHCS now provides guidance for the early intervention funding with Department of Public Health responsible for allocating the prevention funds.

That being said, the Commission, both prior to Proposition 1 and after Proposition 1, had a role in providing independent monitoring of counties expenditures of the millionaire's tax revenue, as well as providing technical assistance, independent research and promoting best practices for behavioral health treatment.

And lastly, Proposition one, like I said earlier, removed the innovative programs but bucket which allows counties and allows counties rather to spend funds from any of the buckets on innovative programs. The Commission used to review and approve county plans for funding from this bucket.

However, with that bucket no longer there, the Commission is allocated $20 million a year to provide grants for innovative programs. So as I mentioned, there's kind of maybe two parts to Proposition 1. The first is the changes that I kind of discussed a little bit before. The second is the bond portion of the Proposition.

So the bond, Proposition 1 authorized a $6.4 billion bond. 4.4 of that is for behavioral health treatment facilities and infrastructure. So this funding is to be allocated under the behavioral health continuum infrastructure program kind of framework. So prior to the bond, this program or bchip was originally allocated $2.2 billion.

And after some budget solutions in recent years, that total amount is about $1.8 billion spread over five rounds of funding. So these fundings were filed, like I said, in the five rounds that focused on different projects which are detailed in the handout on page six.

So our office published an assessment of these kind of previous rounds of funding that we'll be discussing in a little bit more detail in the next panel. But we laid out a number of kind of assessments to help in inform the Legislature as, you know, moving forward with the bond allocations. And so with that, that's the end of my presentation. Happy to answer any questions.

Is there anything else from DHCS or Department of Finance?

I can just provide a very quick brief update on where we're at in implementing and I'm just going to focus on the Behavioral Health Services act since we're going to talk about the bond on the next panel.

So DHCS has been actively working with our stakeholders in current forums and also other new forums that we've created, just really getting all of the legislation and our draft policy out to not only our county partners, but other providers and folks that we're working at with the state level as well, because we have new partners that we're working with at the Housing and Community Development Department, Calvet and others.

And so what we've been doing is putting together all of the policy that our county partners need to submit what was just talked about, the county integrated plan.

So that integrated plan, we just released some final guidance today that requires our county partners to submit a draft to us it's by March 31st of 2026 and the final by June of 2026. So they now have all of that guidance and policy that they need that they have had opportunities to help us create.

But also we've also been receiving a lot of great public comment for that as well. And so we will. We also released today our draft of what that integrated plan is going to look like and that'll be finalized after public comment about the end of June, early July.

So our county partners are actively starting to work at the local level on the community planning process. You know, really looking at all those changes that were just discussed and how they're going to be effectuating that at the local level.

Sabrina Adams, Department of Finance I have nothing to add.

Okay, thank you for that. I actually hear quite a bit about Prop 1 and just am wondering what kind of feedback you're getting in public comment. If there's a way for you to, you know, encapsulate.

Encapsulate that.

Thank you. You can read my sign language.

Yeah. So we, as I mentioned, the public comment that we have has been geared mostly towards that integrated plan. And it is so extensive like this is being released in what we're calling a policy manual because we want it all in one place so everybody can see and, you know, easier implement.

But for each module that we've released, we've received over close to 800 comments. So it really varies what type of comments that we're receiving. Some of it is more individuals not understanding the legislation quite honestly. So it's maybe they want to do something that isn't allowable because it's already outlined in the legislation.

But also there's a Lot of great feedback we're receiving clinically of how many sessions we're setting, levels of care, the extent to all those buckets that were talked about, all of that policy has just been set. And so it's clinical expertise and folks weighing in. So it really has ranged the gamut.

But we have made a lot of changes thanks to that feedback, and not just public comment, but through all of our various stakeholder meetings that we've been hosting.

Thank you for that. Any questions or comments from the Committee? Yeah, please. Assemblymember Patterson.

Great. Thank you. I have some questions for the Department and it seems like we're kind of blending items 2 and 3 together here. So I'll try to keep. Yeah, I know. Well, it's. It's interesting.

So, I mean, I guess I can comment on item one and just remember that from when we get to item three, but Proposition one, you know, when, when the enacting legislation was coming through the Legislature to put it forward, I asked in Committee at the time what was required to get one of the grants.

And in statute it says this, but my understanding is essentially it involves involving stakeholders, including local governments, or there are other things like for example, tribal organizations. Is that correct? Is that your understanding of giving out the Beechip program funds requires some kind of letters of support?

It does require letters of support. Our tribal entities are a bit of an exception since they're sovereign entities, so. But for other applicants, it is required to. However, if they do not receive one, that doesn't mean that they aren't eligible to receive a grant.

Okay. In exact how are you know there's various requirements that are needed to be met to get the funding. I've seen the applications on multiple occasions. Same with an unrelated CCE program, have similar requirements, but different departments. So. But exactly who does the checking within the Department to make sure the statutory requirements are met?

Yeah, I'm actually privileged to be one of those individuals that review all of the bond applications for all the rounds that we've awarded and the ones that are coming with the bond. We also check with other departments for various licenses, depending on the type of behavioral health facility. We also look at like the medi Cal exclusion lists.

So there's various checks that we make prior to an applicant receiving an award. And then once they receive a conditional award, we run deed restrictions and do a lot of kind of back end as well. So if something comes up, we still have the opportunity before the final award is given to evaluate that.

Does the Department use a contractor to make those initial determinations?

So the Department uses a contractor to help us put the information together. But DHCS makes all of the decisions regarding the bond, the BCHIP and the bond.

Yeah. Just to emphasize, again, I remember very clearly, I didn't know this was going to become such a big issue. But in Committee, the Department itself emphasized the letters of support. And I have two projects that are occurring. One of them, which was done unbeknownst to the local government at all.

And it is what the Department is classifying as a tribal organization, although the federal federally recognized tribe in the area has nothing to do with the project. And I've. I've looked at what federal statute is, what's considered a tribal organization. I think there could be much dispute over. I don't really think it's a gray area. But.

But in our interactions back and forth with the Department about the granting of this. Because the entire purpose of the letters of support is because if there are calls for service or to keep people there actually in the facility safe, it requires a partnership with the local government.

And that was something the Department made clear before this even went on the ballot and barely passed. And so I'm very concerned with the grants that have been awarded, not only in my district, but in other places. They don't have those letters of support.

And in one case, not on this program, but also similar program, like I said, the CCE program, the letters of support were from a completely different community, not even the city in which it was ended up being located.

So I just want to emphasize that if the department's using a third party to sort of go through these checkboxes, that I think. I think. I think it should be really sure that the statutory requirements of the law, not just what Joe Patterson thinks. Joe Patterson has a lot of thoughts.

But that the statutory obligations are being met. Because I. We don't want to get in a situation in which money is held up over litigation and things like that. So I just wanted to emphasize.

I don't know if you're aware, I'm sure you are, but my office has been going back and forth a lot with the Department on one particular facility. And the definition of tribal organization and federal law seems to be a little where there's some concern about.

And I think that should maybe be dialed in a little bit on what that means. Because anyways, if you want to respond, you can. I just. I know that the pinnacle of this stressed by the Department and Committee was community support.

Sure. Yeah. I really love this question because it really gets to some of the friction that Is occurring between mental health and substance use disorder facilities.

So when the legislation was passed initially with be CHIP and also with Proposition one, there were, you know, some flexibilities put in, because we have a lot of issues with not in my backyard. Nobody wants facilities near them. And it's especially challenging for our tribal communities.

And our definition in the BCHIP statute and also pertains to the bond has a broader definition around tribal. It's beyond just like a tribal 638 that you may consider, you know, folks may be used to. This is also for our urban clinics and also for organizations to work with an entity, a tribal represented entity.

So in the instance of the situation you're describing, both of these we consider tribal entities that are in line with the statute. We feel as our interpretation.

And so the requirement there isn't a letter of support required from the county behavioral health directors Association, because one of the main reasons we require that letter is because we require medi Cal to be utilized in these facilities. We want this to be for our safety net population.

But our tribal entities are funded differently since they're sovereign nations. So we didn't feel like we needed a county behavioral health Director letter for those tribal entities. So there is, though I do have to state there's not a letter of support requirement in the statute.

That was something dhcs instituted because we wanted to understand what we hear from the communities. But it is not an actual statutory requirement.

All right. I do have the statute up and the. The requirements from DHCS that are part of the program. I don't know. So is that an underground regulation then, that DHCS has created?

No. So we have authority to set all the requirements for BCHIP. We don't have to establish regulations. We have that authority in the statute as well, what we call bulletin authority or any sort of similar instruction, which for us is our request for application. So it is. I want to clarify. It's not in statute.

It is part of the request for application process. But we also state if they don't submit the county letter of support, we still will accept the application. So. And once again, though, for our tribal entities, they are not required to have a letter of support from the behavioral health Director.

They are to have one from their, like, tribal entity that they're, like, submitting the application with. But that is the requirement around the letter of support.

Okay, okay, I'm reading the statute. And so maybe we can just get some clarification on that, because I'm the welfare and institution codes 5960.3 the project applicant submits to the lead agency a letter of support.

So there or other documentary, documentary proof for the project from a county, city or other local public entity for any new proposed construction, major alteration, work or rehabilitation. That's from the statute.

And is that for BCHIP or CCE?

It's from BCHIP, yeah.

Maybe we can talk more in depth later and more than happy to answer any of your questions around it, but I'm not familiar with that being a part of the BCHIP statute, but happy to discuss it.

Just one final comment is that, yeah, this is the Behavioral Health Continuum Infrastructure Program. But one other comment on that is I think it's very sensitive in, you know, again, I understand the not in my backyard philosophy.

And this legislation was negotiated with that in mind, still saying a letter of support rather than approval from the local government. And that's why there were CEQA waivers for the legislation. Again, having participated in the hearings at that time.

But I completely agree that tribal organizations are unique and should get some special emphasis in how they can take advantage of these billions of dollars in funds.

But also I might submit that when a tribal organization is putting a facility in the area of another federally recognized tribe in that area, that there should at minimum be some collaboration.

And I would say that if DHCS has the latitude to make some rules around that, I think that cooperation is really important for the federally recognized tribe in that area to be a part of the process.

We'll definitely take that into consideration.

Nothing else. Okay. I think what we'll do, since there's so much interest in BCHIP, if you have public comment, if you wouldn't mind holding it, we'll go through issue three and then we'll take public comment because perhaps things that are on people's minds will be clarified a little bit more as we move on to issue three.

So we are going to talk about bchip, the BCHIP bond and the Behavioral Health Bridge Housing Program. And then we will take public comment on both issue two and issue three. The background for this item is on page 14 of your agenda.

And we are asking the Department of Healthcare Services to provide an overview and update on BCHIP and its bond equivalent. An update on the Behavioral Health Bridge Housing Program. And then we will ask the LAO to provide a brief summary of their BCHIP analysis. So please go ahead and introduce yourself.

And you have about five minutes for the Department, about five minutes for the LAO.

Great. Thank you so much. I failed to introduce myself prior, so I apologize for that. Marlies Perez with the Department of Health Care Services. I'm the chief of the Community Services division and also the project Executive for Behavioral Health Transformation.

And so we've already kind of jumped in a little bit on bchip, but just some really quick background. It was legislation was authorized in 2021. We have since awarded 1.7 billion through five rounds of funding.

The main rounds of funding that I want to talk about today are rounds three through five because that's the real bricks and mortar infrastructure. So we funded over 130 projects. And so these projects can have multiple facility types on their project.

So we've actually funded 223 mental health and or substance use disorder distinct facilities in these 130 projects. So with this. When we are looking at the applications, as we kind of already talked about here, we are really looking for lots of different things. We have broken up this funding through geographic regions.

So we're looking at the need geographically. We're looking at the local need as well. We also have conducted quite thorough needs assessments from the Department.

We've also had the RAND study that folks have talked a little bit about in the LAO report and I'm sure we'll discuss a little bit here today, which is a focus on adult inpatient mental health beds. But also that local need that we talked about earlier.

That comes up a lot as well because we really want to ensure that the local need is being met, but also that we are serving that safety net population.

As we've talked about, there's a letter of support where individuals from the county behavioral health Department, they have to submit that letter for projects because we want to ensure that they have a connection there for that medi Cal funding also.

So in the round of funding, the LAO partners are going to talk a little bit about the reports. But I want to talk a little bit of the focus of the Administration really has been that medi Cal population. But you're going to see there are some facilities we awarded that maybe were at 20% or so.

And you might. Why did you do that? Because there are facility types that are serving very specific populations. Some of those are for our justice involved. And they may not have a high medi Cal.

They may have a high medi Cal population, but they may have other funding sources that are used for that kind of step down into residential care or maybe specialized projects for children and youth as well. And so if they have other funding sources, they may not have as high medi Cal.

So those were very specific awards that we made in those areas. And then also for the discussion around the inpatient beds and you'll see some charts that the LAO had. I do just want to point out that we really looked. Not all facilities take Medi Cal.

There's a lot of facility types that do not want to take Medi Cal. And so the county, we may have funded an inpatient mental health facility because the county actually, while it looks like they have enough access, not all of those facilities take Medi Cal.

And so they really need this particular facility to come online that has agreed to provide Medi Cal services. We also have a really big focus on campus models once again, so we can have that as much of that continuum of care that we have for that individual that may be stepping down into services.

So that's been a real focus of the Administration as well as regional approaches. Especially in our rural areas, they may not be able to have or really fill a whole facility that's residential. But other counties are going to part partner and come together and use those types of facilities as well.

And so as of March, we have eight facilities that are open and providing services. There's actually 19 that are done construction but are in the various stages of getting their license or maybe furniture in order to actually open and provide services. So I'm going to quickly move into the bond. So we have.

Of the over $6 billion in bond funding, we have 4.4. That is at the Department. We are literally in the process of awarding the 3.3 billion. It's really exciting time. We have received close to $8 billion worth of applications, almost 300 applications. So we're in the process of whittling it down.

I'm going to get on a flight after this because we're actually making some of those preliminary decisions this week. It's absolutely phenomenal and really exciting to see the level of applications that we've received and to be able to fill some of that need out there.

So we've learned a lot of lessons through the awarding of rounds three through five and also from our partners at LAO with their report. So we're really taking these into consideration as we're making these awards. We are also really looking in. You'll hear from the LAO report, the rural areas.

We have some counties that have not been able to apply. So we worked with those counties and reached out. A lot of them actually have received round two planning grants to kind of look and see.

You know, we've provided a lot of TA and some funding to help them either hire a grant writer or make a plan in order to increase their capacity. But Then we've done other reach out like how can we help you get an application in?

So I'm very excited to say we have now seven rural counties that have submitted applications that haven't received AB CHIP award. You're also going to hear about some areas like in the San Joaquin Valley that need a lot of assistance. We're super excited that we've received a lot of applications from the San Joaquin region as well.

So with that we are, like I said, we are in the throes of making decisions and we are expecting to make announcements in May for that 3.3 billion. Then we're going to put out our next request for application and that will be for up to about $1 billion and make those awards in next spring.

And with that I'm going to move into behavioral health bridge housing. Sorry, it's a lot of information but with behavioral health bridge housing. So we're really want to move your hat now before we're talking about facilities, treatment facilities. Now we're moving into housing. So DHCS has awarded over 1.1 billion for housing services.

And this also has some new housing infrastructure. This funding went out to our county and tribal partners and this really is around temporary housing for individuals that are experiencing a behavioral health condition. And so we awarded our last round of funding in July of 2024, which is a little over 130 million.

As of this last December we have served more than 5,000 individuals. And that is since we started in the winter of 2023. And so we anticipate funding over 7,000 beds across California with more than 3,000 of these bed created through that infrastructure funding.

And it and really what this is going to do is directly expand the housing stock. And so as of this last December, we have over 2,000 beds that are operational and supporting either using the infrastructure Monday that I'm talking about or the services funding.

And so with that we of course provide a lot of Ta and training around bridge housing and then we have a lot of technical assistance as well. That concludes my comments.

Thank you. Go ahead, please. Yes.

Good afternoon, Madam Chair and Members. Mark Newton with the Legislative Analyst Office. We've been asked to provide a summary of our recent assessment of the beat chip program to date. Just to give a little context for why we did the assessment and maybe the purpose of the assessment.

As has been mentioned, $1.8 billion has been awarded to date in the BCHIP program. The Proposition 1 bond provides a further 4.4 billion that the Administration hopes to start awarding very soon in May.

Our goal was to look at the outcomes of the awards to date with the intent to inform the implementation of the bond, a level of funding we haven't seen to date, and also to assist the Legislature in its oversight of the Proposition 1 bond implementation.

Basically, in conducting our assessment, we asked a basic question, and that is to what extent have the awards to date addressed the most sort of acute sort of shortages in the regions of most sort of most need? And just a little bit of background in terms of data that are available.

One area where there's a lot of data is actually in the area of adult inpatient mental health beds. And a 2022 RAND study looked at sort of the need statewide, found I think it was 7,800 beds. So we're able to then assess beat chip awards to the extent of addressing sort of that shortage.

But there are a whole plethora of other types of behavioral health facilities or so, and data are more limited in terms of knowing sort of what is sort of the current capacity and what is the need.

So in looking at the BCHIP awards to date, we developed a methodology where we looked at sort of relative need of regions across the state based on rates of serious mental illness, opioid overdose deaths, and similar measures. So turning to the handout, you'll see a number of our findings.

I'd just like to summarize them and maybe raise some issues for the Legislature to consider. So the first issue we looked at is just who is benefiting from from the BCHIP awards to date. And our review did find that over half of the awards to date are for projects that serve at least 80% of Medi Cal Enrollees.

And this makes sense given that it makes sense that the state would prioritize this population, given the state's role, responsibility for the Medi Cal program, and also given the disproportionate number of the medi Cal population that have behavioral health challenges. So this does make sense.

Now, in terms of looking at other populations though of concern, this is where it gets a little trickier to evaluate sort of the state's progress because of data limitations.

And thus we in our report recommend that the Legislature ask the Administration for more detail on the extent to which the BCHIP awards to date are benefiting children and youth, American Indian, Alaska Native population, as well as justice involved individuals. These are populations that the Administration has identified as populations of concern.

But data did not allow us to do a full evaluation of that. Turning to the next issue, and this really was the. I guess the focus of our report is how well have the awards been aligned with. With needs in the state. And this is where we do think there can be some improvement mentioned.

And I note that the Administration has mentioned that they've taken some of those findings to heart and are making sort of changes to address perhaps some areas for improvement. The first area relates to the methodology that has been used by the Administration to date.

And it's essentially allocating funding, largely allocating funding to seven different regions of the state. And that amount of allocation was based on a historical funding for realignment back many years ago. And then once the funding hits the region, then it's a competitive grant, competitive grant program.

We think that that regional funding methodology actually, in a way can exacerbate some existing inequities sort of in the system, given that to the extent that historic spending on or funding for behavioral health in an area may not reflect sort of needs today. So to the extent inequities in the past somewhat reinforcing that.

Also the there are regional inequities in the adult inpatient mental health bed capacity. And as we note that most of the new capacity that has been added by BCHIP funding to date has been in the four regions that were estimated by the RAND study to actually have the least need.

And with no new capacity being added in the region of the greatest need, which is the southern San Joaquin Valley. And again, the Administration mentioned sort of an attempt to address sort of that issue. A next finding of our assessment was that the BCHIP to date did not seem to be working well for all small counties.

And the Administration has made efforts in the awards to date to actually prioritize to some degree small counties. And there is a certain percentage of the funds that have been awarded at DHCS's discretion to small counties. There are, I guess, 30 small counties in the state.

11 got a concentration of funding, but with 19 of the small counties not receiving any funding sort of under this. So this is just sort of an issue of equity and addressing sort of needs in the small counties.

And this leads us to probably our final finding in our assessment in that the BCHIP program may not be working well for all grant applicants. There was some discussion a little earlier in terms of some of the requirements to be competitive.

We found that the process had been challenging for some applicants, a preference perhaps understandable to give preference to launch ready projects. But those may not be in smaller, more disadvantaged counties, may not be able to have the resources to actually have or be able to advance launch ready projects and the like.

So as a final sort of issue, the program should consider going forward sort of barriers to some smaller disadvantaged applicants in counties and addressing those to ensure that the funding sort of is equitably provided as well as addressing the needs of the state. Happy to answer any questions. Thank you.

Thank you for that. Anyone else on the panel before we. No comments? No. Okay. I just wonder is there anything you want to respond to from the LAO? Not that we want it to be a back and forth, but I did hear you address a comment or give a comment that you are trying to work with some of the counties that hadn't put in applications. Is there anything else you'd want the Committee to know around efforts?

Yeah, I think one thing I'd like is this is extremely obvious but we can only award who applies. And so we have such a need across the state.

And for our first rounds of funding where we awarded the 1.7 billion every time we put out an application we had more applications than we could actually, you know, award because of the funding. And you heard with the bond we have 8 billion in applications to award 3 billion.

So it's a little challenging like and it's the analysis by our LAO partners has been phenomenal. But there are so many different facility types that we're looking to, you know, who do you Fund which is the more important. And it's very challenging because the need is so high.

And so with the launch ready that was part of our initiative is we really need to get services out there. But we also took applications from all varying folks, you know, depending on what level that they were, whether they were launch ready or not, especially in our small counties.

And it was pointed out in the LAO report we used our discretionary funding to Fund. So our small counties proportionately received more of the funding of BCHIP based on size because we know there's such a need up there. So we are very excited about with the bond that we'll be able to fill in more of that need and with the San Joaquin Valley as well.

Thank you for that. I share the concern around using sort of a historical process to allot today's dollars and it's something I've really struggled with in a number of areas that sometimes we do deepen the inequities when we look at how we've done things in the past.

And then we take new monies or new perspective, but we use sort of old methodology and it can make things worse. So I want to appreciate the LAO's perspective.

I have a couple of questions questions and then I'll turn it over to the Committee and it sounds like the Behavioral Health bridge housing program has been successful, yet the Administration has eliminated round four of the funding. Is that, is that. So that's with the bridge housing? Yes, with behavioral health bridge housing.

And so can you, given that it has been it sounded from your testimony like the behavioral health bridge housing program has been successful, yet round four of the funding is eliminated. And so I'm just wondering what's going on there, why that would be if we're starting to see success in this.

Lizbeth Castillo with the Department of Finance. So as Marlies stated, the Behavioral Health bridge housing program. Well, the Governor's Budget continues to invest 1.1 billion in the behavioral health bridge housing program. And Governor's Budget does propose to cut or eliminate 27.5 million General Fund and 90 million behavioral health services Fund for the program.

And this is due to the Administration considering other significant statewide investments aimed at addressing similar efforts such as homelessness and initiatives that support individuals experiencing behavioral health conditions and substance substance use disorders.

In addition to this, it was somewhat alluded to previously, but the Administration is evaluating the significant administrative workload associated with the implementation of Proposition 1 behavioral health transformation. And to the extent that the Behavioral Health Services Fund revenue is available for state directed purposes at May Revision, we aim to prioritize funding for these efforts.

So in essence, are you moving the behavioral health bridge housing round four funding to something else that will provide this kind of bridge housing or completely to different kinds of services?

It's more of the Administration is evaluating how the funds can be used given upcoming and ongoing administrative workload that comes with the behavioral health transformation and the implementation of Prop 1.

Okay, and secondly, I'm switching gears here, but there's been a number of very, very troubling headlines around for profit psychiatric hospitals and and that includes evidence of patient neglect, violence, allegations around preventable deaths.

However, these for profit entities are eligible for BCHIP funding and so want to know how you're in a preventative mode knowing that there's limited funding that we need to get the funding to the right places, the right communities, but not give this funding to private entities that are committing really egregious things, according to the reports. And what kind of safeguards are in place around private psychiatric hospitals or anyone for that matter.

Great. Yes. So we did award eight psychiatric hospitals through those rounds, three through five that I mentioned earlier. Two of them were for profit. However, before any awards are made, we work with all of. So we hold a lot of the licensing and certification processes at DHCS.

I would estimate maybe 85%, of course, the Medi Cal certification as well. But we do work with CDPH and DSS because they hold some of those authorities as well. So we do a thorough check with them before we even make any awards.

So they've already been looking at with the bond, everybody that's applied, complaints, licensing actions, anything like that, and then also all of the exclusion lists and everything, because we are just as concerned as you are. We want to award providers that are going to provide safe services for individuals.

So for the bond, we did look and see for acute psychiatric hospitals. We've received 18 applications. And so once again, all of those are being vetted as well through our process. And so obviously we don't know how many are rewarding at this point.

This point, but there's various ones, they're either for profit, county or non for profit, that have applied.

And is there a process if you've awarded funding, if you award funding and then one of these facilities is found to have committed some of these egregious things?

Yeah, so there's a lot of processes that we have in place for accountability through not only the construction process, but we also have, they have to be providing services for 30 years and we have the authority during that whole period. It's a monitoring time to ensure that first of all, they're providing behavioral health services.

But also if there's any sort of actions that are occurring that we have authority to have them return the grant funding.

Thank you. Any questions from the Committee Assembly Member Schiavo?

Could you. The chair asked most of the questions I had, but could you just talk about what. Can you give a little bit of a picture of what kind of applications you're receiving, what they look like, are they different in rural areas than, you know, more high population areas and how, you know, just the whole kind of the array of services and how they're, you know, getting those mental health supports out to folks?

Sure. So we are receiving quite the gamut of applications and it really does vary across all of California, as I mentioned earlier. I mean, I get the privilege of reviewing every single one.

And you know, there really, you can see a difference when someone has a grant writer versus somebody that maybe at the county level has put this together. But that's not the concerning piece for us. Our concern is like, where are these services going to be provided?

Is it going to be a, you know, we're also looking can they get the project done on time? And really making sure that we're not picking any fraudulent applications as well. Because we recognize with such popularity that, that that could be the case also. So it really, really varies.

Some of our applications are just for one type of facility type. We get a lot of outpatient facility requests in like rural areas because like I mentioned earlier, they, they may not be able to sustain a full residential facility.

So when we see a residential facility that other counties are going to use, that's going to be very, you know, important for us when reevaluating it because we want to make sure we're increasing that access. I do just want to talk about the regional awarding.

The reason we chose that model is like one of our regions is balance of state, which is a lot of our northern rural counties. So they're competing more against each other.

So recognizing then like maybe the quality of applications aren't as good as perhaps like an LA area where there's so many more and there's just, it's more competitive. So we're looking at it like that as well because it isn't the quality of the application that gets the award, it's what's being built.

That's really what we're honing in on. So we have felt by having that regional application, you'll also. Excuse me, distribution of funding.

You'll see we also had a tribal set aside that was really important to us, recognizing those are our highest rates of suicide and overdose and that has the least amount of access and then that 20% for us to make the decisions of. Okay, where are we still seeing the need and where can we put that funding?

So it is really varied. We've awarded some that have anywhere from seven to nine license types on these huge campus models that are serving a lot of people.

Or it might be a smaller mental health substance use, you know, outpatient setting that also has prevention services because it's the whole continuum from prevention, treatment, recovery services and harm reduction that we're trying to Fund for mental health and substance use. So it, it really is varied.

Thank you. I think now we'll move to public comment on both issues 2 and 3. So if you have public comment for issue two or three, please keep your comment under one minute. And if you're speaking on a previously stated position, please only provide name Organization position.

Good afternoon, Madam Chair and Members. Angie Manetti here representing the Steinberg Institute. We thank the Committee, the agency and the Department for your work to implement Proper One, BCHIP and BHConnect. We're so excited about the potential these programs have to change lives for California's most vulnerable.

However, we're concerned about the state's outcome and accountability framework for behavioral health transformation. We don't believe that the Data recommendations from DHCS's Quality Equity Advisory Committee appropriately leverage the depth of the data the state has available to measure the impact of bht.

This information is essential to ensure that we are continuously improving the quality of our programs to deliver the outcomes we're striving for. Failure to track outcomes was one of the largest failures of the mhsa and it's essential that we not repeat that failure with BHSA.

We'll share a letter with the Committee Going into greater detail of our concerns and recommendations and thank you so much for the discussion.

Good afternoon Members. Diana Luna with the County Behavioral Health Directors Association, representing the County Behavioral Health directors for California's 58 counties, first wanted to touch base on the BCHIP bond funding consistent with the concerns raised regarding the previous rounds of bchip.

We urge the Legislature to prioritize regional needs for Round 1 and 2 of BCHIP funding conforming with the RAND inpatient bed analysis commissioned by Cal Mesa.

We would also like to raise the need for prioritization of BCHIP Round 2 funding and BHSA workforce dollars to increase Fund substance use disorder and forensic treatment capacity and address timely treatment needs. This would ensure successful implementation of recently unfunded initiatives such as SB43 and Proposition 36 treatment.

Secondly, on the BHBH Round 4 elimination, first off, we want to thank the Members for raising concerns around the elimination of Round four. Echoing the comments made, CBHDA respectfully urges the Legislature to reject the proposed reduction.

The proposed elimination of Round four will result in a six month to one year gap between the program's subsidies currently underway and the new Medi Cal Transitional Rent Benefit and BHSA housing subsidies which are expected to go live in 26-27.

This gap will result in thousands of county behavioral health clients to lose their housing and most likely increase homelessness among the population of individuals with significant behavioral health conditions. Thank you.

Hi, good afternoon. Chair and Members Beth Malinowski, the SEIU of California on behalf of our county behavioral health workforce, want to appreciate the conversation today. Specifically on issue two.

We continue to have optimism for the promise of the change and transformation that's before us, but the same time in some parts of state starting to really feel some caution for a number of reasons.

One, as we start to see signals from some county partners of potential program closures or workforce reductions as funding shifts to meet the new Proposition one needs.

And with that, I think that really just speaks to the importance of making sure that labor is at the table at these local processes that are playing out throughout this year to make sure that as we really look for that planning process, that community process that's inclusive of labor, I think furthermore just speaks to the role that all of you play in just holding our local jurisdictions accountable as we move forward in this work. So thank you.

Good afternoon. Chair and Members Omar Altamimi to California Pan Ethnic Health Network, or CPEN. CPEN urges state leaders to consider Prop 1 implementation in our broader health and behavioral health context.

Prop 1 enables California to push forward our values without being constrained by national politics, which is particularly important at a time when the rights and healthcare of people of color are under attack.

Unfortunately, Legislature did not take the opportunity of this initiative to generate additional revenues for our safety net and we hope that will be seriously considered in the future as we face future cuts for Medicaid and behavioral health funding.

We urge the Administration the Legislature to strengthen the explicit focus on reducing racial disparities through BHSA funding, including holding counties accountable for meeting measurable equity goals, including specific language access plans for their programs to address language access concerns that we continue to hear frequently and specifically to issue three.

We appreciate previous comments and discussions regarding for profit private facilities and want to re emphasize our concern about the lack of oversight of existing for profit inpatient behavioral health facilities and request that DHCS and CDPH provide more information about their capacity and expertise to effectively oversee a growing number of these facilities given the BE CHIP funding.

Recent reporting by the San Francisco Chronicle documented alarming and frankly abhorrent conditions in these facilities despite substantial profits being made by these for profit facilities. We urge that not be additional state investment in companies that are flagged as bad actors and care for vulnerable individuals. Thank you.

Good afternoon. Elle Grant on behalf of the California Alliance of Child and Family Services, I just want to echo the comments of CBHDA about the rejection of the delay of round four in regards to Prop 1 and also just to say that we think it would greatly benefit the community to have CBD community based organizations heavily involved in the implementation of Prop 1 to ensure that the services are reaching the community Members where they are. Thank you.

Seeing no other public comment, we're going to move to issue 4 Children and Youth Behavioral Initiative. This is a $4.1 billion initiative focused on children and youth and at our last hearing we heard about one critical component which was the school fee schedule.

For this to cover the bulk of the remaining elements of the CYBHI program, we are asking the Administration to provide an overview of the various work streams included in the initiative and provide an overview of their recent annual interim report on the initiative which was recently released. Background for this issue is on page 19 of the agenda and you'll also find a table outlining all of the funding line items related to the initiative.

We have also posted on the Budget website a copy of the CYBHI annual and interim report and as a reminder, you have about four minutes for your testimony and go ahead and introduce yourself and ready to hear from you.

Sounds good. Good afternoon. Sohil Sud with the California Health and Human Services Agency. I'm a practicing pediatrician and I serve as Director of the Children and Youth Behavioral Health Initiative. I will provide, as requested, a brief overview and status update of CYBHI and then pass over to my colleague from the Department of Healthcare Services.

So as you well know, CYBHI is founded on our collective and resolute commitment to better support young Californians by establishing the conditions such that every youth has somewhere or someone they can turn to in moments of stress and despair, be that themselves, through efforts to build resilience, their friends through messaging campaigns and peer support programs, their parents or caregivers through a host of different programs, the digital world that they navigate on a daily basis, their schools, their communities and their healthcare spaces where they receive clinical services.

The Initiative is seeking to heed the call of our youth to meet them where their lives are lived, to be prevention oriented, youth centered and equity focused. In terms of where we stand, the Chair just mentioned some of the reports that were recently released about that.

I would say overall a lot has been done and there's a lot more to do. So to date, over 1,300 organizations have been awarded more than $2.1 billion to conduct more than 1,800 separate activities. In this realm, more than 50,000 individuals have been supported along their behavioral health career path.

Three campaigns have been launched with important and distinct messages to which Californians have now been exposed over 1.3 trillion times, and in a moment you'll hear more about first in the nation approaches that have been launched to provide free and high quality services in schools and online, two places where youth spend a lot of time Equity Drives the Mission each of the 20 work streams has individualized equity priorities, but overall there's a focus on populations identified by the California Reducing Disparities Project, as well as populations with known needs in the behavioral health space.

The ultimate question is, of course, are these outputs changing outcomes? Are they making a difference in the lives of our youth? And while population level data on these types of outcomes is not yet available for the most recent years in which implementation really has taken off, early findings suggest we are moving in the right direction.

So CALHS is working with the research firm Mathematica to evaluate the initiative and last month, as has been mentioned, they released an independent interim assessment which suggested that, number one, the strategy is aligned with evidence to influence outcomes, that the investments are aligned with geographic areas of increased need, that the initiative is expanding workforce capacity and representativeness, and that certain flagship programs like the Fee Schedule Program and Dyadic Services have the potential to significantly change the ecosystem but need to progress further.

Additionally, what I can tell you is that schools have noted improved attendance after instituting behavioral health supports and services on campus, as has also been corroborated by various analyses conducted by UCLA and UC Berkeley.

Primary care providers have stated that their patient psychiatric care improves when consulting with experts, and youth have noted that the new spaces and platforms being established provide important havens of support.

And I'll close by referencing one LGBTQ youth who noted that the skills he learned about suicide prevention through a community organization funded by CYBHI helped him save a friend's life. So that's why we do this work. It's occurring imperfectly and we welcome your questions.

We need to continue to scale and integrate and sustain and so that hopefully we can see the improvements I noted manifest on a population level. So thank you for the opportunity. I'll now pass to Deputy Director Boylan.

Good afternoon Committee Members. My name is Autumn Boylan and I'm the Deputy Director for the Office of Strategic Partnerships at the California Department of Healthcare Services.

DHCS administers 12 of the overall CYBHI work streams, leading investments in school based behavioral health services, evidence based and community defined practices implementation of new Medi Cal benefits such as the Dyadic Services benefit and Certified Wellness coaches in the medical program and digital strategies designed to improve access to behavioral health services and supports for all children, youth and families in California.

Today I will highlight some of these work streams and pathways to sustain this extraordinary investment in the health and wellness of California's youth.

I'll begin with discussing our efforts related to school based services, some of which you heard about in the prior hearing, but we administer several complementary work streams to improve access to behavioral health services at public schools including colleges and universities across the state.

The Student Behavioral Health Incentive Program provided incentive payments to managed care plans to partner with school districts across the state to provide a set of targeted interventions including access to preventative early intervention and other behavioral health services provided by school affiliated behavioral health providers through BCHEP or Relationships between managed care plans and school districts have strengthened and now many school districts throughout the state have direct contracts with managed care organizations that didn't previously exist so that ongoing funding and support through our managed care organizations can be provided in school based settings.

We have also invested in social and emotional learning strategies through the 58 County Offices of Education and Local Aging local educational agencies or LEAs in each county, including making Investments for well Being and Mindfulness Grant programs which provide funding to county offices and LEAs to Fund student facing programming in school districts in each county Investing in data sharing infrastructure to enable schools to assess well being of the student population through Kelvin Pulse surveys which assess the well being of the student population at each school site and support SEL competencies and leadership of school district staff through the state through dedicated SEL learning courses and certifications.

Further, DHCS invested $400 million in School Link Partnership and capacity grants to county Offices of Education and LEAs across the state to ensure that they could Fund the necessary infrastructure to stand up the CYBHI Fee Schedule Program and at least 70% of the total grant funds for that program must be used by LEAs and county offices of Education to make fee schedule related investments.

The goal for all LEAs in the state as well as the California Community Colleges, California State University and University of California campuses to participate in the CYBHI Schedule Program which will provide a permanent source of funding to school schools to not only sustain all of the other CYBHI school based services investments described above, but to maintain and grow access to behavioral health services for students across the State of California.

As you heard in the previous hearing, the CYBHI Fee Schedule Program represents a significant transformation in California's educational and behavioral health systems. It requires close collaboration between county offices of education, LEAs, colleges and universities, medical and commercial managed care plans, insurers and multiple state departments.

We all heard from some of the COEs and LEAs about the challenges that some of them have experienced in standing up this program, and I wanted to note that this is a significant change for the entire system and a change of this magnitude takes time.

DHCS has worked collaboratively with COEs and LEAs to design and implement all aspects of the policy and operational framework for this program, and stakeholders have raised concern to the Department and to this Committee about the process and delays in the process.

However, we intentionally took time with the county Offices of education and LEAs as well as other statewide education partners to listen to their concerns and collaboratively design this policy. When we've tried an approach that has been less successful, we made changes to improve the way that we operate the program.

When we've heard LEAs express concerns about difficulty completing onboarding prerequisites, we've made changes to the forms and templates to streamline them and make it easier. We have also created additional training and technical assistance opportunities via recorded trainings, live workshops, and weekly office hours sessions.

Further, based on direct feedback from LEAs, Carillon Behavioral Health, the state's third party administrator, is establishing direct data connections between the managed care plans and insurers to reduce the administrative burden by LEAs related to collecting student health insurance information. But again, all of this infrastructure connection takes time. The infrastructure, though, is in place to pay claims.

Today, nine LEAs in Cohort 1 have submitted 41 claims total. Additionally, 20 additional LEAs have completed all necessary steps to submit claims, and we've been working closely with the Cohort 1 LEAs to increase the number of LEAs that are completing this onboarding process to be at the ready stage.

Throughout the process, LEAs have shared a variety of reasons for the delays. Examples include having requested edits to the provider agreements and standard templates for data sharing. They've expressed confusion around the process and are awaiting guidance from dhcs, which we acknowledge.

And there are a significant number of Cohort 1 LEAs that are working through processes internally or getting vendor contracts in place or intentionally waiting until the next school year to begin submitting claims for those LEAs that have already submitted claims.

Each has only submitted a small number of claims to date, and there are no barriers preventing these LEAs from submitting claims for all services provided after July 1, 2024.

We're working closely with these LEAs to provide them assistance and we expect that the volume of claims through this program will grow quickly as LEAs become more and more familiar with the claiming process.

We're also working closely with community based providers across the state to provide technical assistance and working closely with organizations like Hazel Health to ensure that affiliated community based providers who are working with schools to deliver support to students can also participate and expediting their pathway to participation in the program.

I also wanted to share some updates about the digital services and supports programs that we've launched through the cybhi.

Bright Life Kids in Saluna are two of these examples and they represent a first in the Nation strategy to provide free, preventative and culturally responsive mental health support to Californians, children, youth and caregivers, particularly in remote and underserved areas. Saluna and Bright Life Kids give youth and families unprecedented access to mental health services.

They offer telehealth services that are accessible online and via mobile applications. The services are available in up to 19 different languages across the state and they offer flexible hours and culturally relevant and specific content for our diverse communities in California.

A primary goal of both of these programs is to eliminate traditional barriers to care such as long wait times, cost, transportation, limited provider ability, scheduling conflicts and stigma around mental health.

At the end of February of 2025 or as of the end, there are over 195,000 users of Saloona and Bright Life Kids across all 58 counties in California and those numbers are growing rapidly in 2025 compared with prior months.

The word is getting out and 70% of all of the users that responded to user surveys have reported that the coaching provided through Bright Life Kids in Saluna is our first and only source of professional mental health support for themselves through Saluna or for their children through Bright Life Kids.

38% of parents using Bright Life Kids share that they have, not that they have had a hard time accessing behavioral health or mental health services for their children due to one or more barriers, and one in three users on Saluna have reported that without the Saluna program, there wouldn't be access.

They wouldn't have been able to access care due to financial, logistical or personal barriers. Both platforms are intentionally designed to serve communities that have historically faced the greatest barriers to accessing behavioral health services, including communities of color and those in under resourced geographic areas.

50%, 56% of Saluna and 73% of Bright Life Kids users self identify as black, indigenous or people of color and and the platforms are reaching families in areas that fall within the lowest half of the Healthy Places index. More than 50% of all users are in the lowest HPI quartiles.

This type of early intervention prevents escalation to higher levels of care, including crisis intervention emergency room visits and hospitalization.

Saluna has delivered 19,660 mental health coaching sessions as of February 2025, with 47% of those sessions occurring outside of regular business hours and with a less than 5 minute average wait time for access to support for Bright Life Kids. Over 23,000 sessions with coaches have been delivered and the average wait time is just 1.6 days for appointments.

This is vastly outpacing what is available in other community based settings and Saluna and BrightLife Kids are both backed by evidence based by a strong evidence base and evaluated using a comprehensive framework that aligns with CYBHI's overarching goals. A formal evaluation is being conducted by Mathematica as Dr.

Sud mentioned, and in the meantime we are collecting data across a wide variety of indicators which are showing improved outcomes for mental and emotional well being for those that are using Saluna and Bright Life kids.

For example, 88% of families using Bright Life Kids report that they're meeting behavioral health improvement goals after participating in coaching sessions, 99% of saluna users are reporting that they're feeling heard during their sessions and 82% of saluna users reported feeling less alone and saying that they are better equipped to support others, themselves and others after engaging in the platform.

Both BrightLife Kids and Saloona operate under specific service level agreements and performance based contract terms, and the contracts are aligned to realistic growth expectations over time, meaning that we are not paying for more than what we are getting in terms of the number of people that Saluna and Bright Life Kids are serving.

The contracts are based on a tiered payment structure so that we are only paying for the population tier that we are achieving in terms of utilization.

The initial investment though was instrumental in building a statewide digital infrastructure and standing up these programs, which is shown through early engagement and the increase in utilization since we launched in January of 2024.

By engaging others who might otherwise seek or be able to access traditional care, the platforms reduce friction across the behavioral health system, alleviating pressure on schools, county agencies, and hospital urgent care and emergency services.

They're designed to complement, not replace, the broader behavioral health ecosystem and they operate as critical entry points into California's broader behavioral health and social services network for children, youth and families. Thank you.

Any other comments panelists? And I want to appreciate you going into depth on the digital platforms because that was the bulk of my questions had to do with how you're looking at efficacy and if you're actually collecting data on how helpful these are, not just who's using them and how often you're using them. So appreciate that.

So I don't have further questions. Do you have any questions? Assemblymember Schiavo?

Yeah. So I also appreciate the information. I mean, it's just when you're looking through, I think there's, you know, 27 line items or something right here. And such a huge chunk of it is going to soluna and bright life kids, I hear. You know, I hear.

And obviously support more access in rural areas where it's challenging, you know, in multiple languages, culturally appropriate, all of that.

But it feels like in our last hearing we, you know, talked about some of the challenges that were around the delays in the, you know, fee schedule and ability for schools to be able to Bill for the work that they're doing and in some way like to have such a large investment in this one state space.

And then it feels like some of that money could have gone to make this process go faster so that people could have, you know, or schools could have been able to really get up and running and be able to Bill and not give pink slips to staff that they worked so hard to recruit. Right.

If we're trying to create schools that are these hubs for services and care and support, it feels like this is a drain on that in a way, because so much resources are going into these apps and online portals and virtual or remote care when you could have care in person.

And we know, I mean, care in person is really important. We don't need everybody being on a screen trying to talk about how they're feeling. They need to be with someone who can see them, who can see their body language, who can understand what they're going through and what their body language is telling them too.

I think the in person piece of it is really important. And while I understand we may need to fill gaps with some apps and other technological programs that can be an important tool. I'm concerned about much of the total budget being sunk into these.

When schools are literally issuing pink slips right now because they cannot Bill for the work that their mental health workers are. And we know that there's a shortage of mental health workers.

If schools are lucky enough to hire people and actually get them on staff, I'm really concerned about them then leaving them because they're probably not used to what can sometimes happen where you get pink slips and then you end up getting hired back again. I mean, people are going to.

Mental health workers are so sought after right now, they can just go somewhere else. So can you speak to kind of how I think about balancing this in, you know, in the context of the struggles that schools are having right now. Sure.

A couple of things I'll say there. First, the LEAs across the state, many of whom spoke at the last hearing, are participating in the reimbursement program. And there are no barriers for them submitting claims. So we're ready, we're supporting them to make sure that they can get reimbursed for the services that they're providing to students.

We have been flexible in terms of some of the statutory deadlines for submitting claims to let them still be able to go back to the beginning of July. And really it's about making sure that they submit the claims and we can pay them.

There are things, as I mentioned in my comments, that we're working through with all of those LEAs that are participating in that reimbursement program. And there's a variety of reasons why school districts are at various stages of implementation of that effort. It's been a big, a big learning curve for all of us.

But this investment around the digital support programs, first of all, was these are separate investments. They're not one taking away from the other one.

And if you total up the investments for school based services that I just spoke about, it's about $1.0 billion worth of funding that went to schools as a result of the Children in Youth Behavioral Health and Initiative.

So I would argue that the largest investment is actually not the digital apps and programs, but it's actually school based services. And I do want to make sure that the Committee is tracking that. The budget for the digital services behavioral health platforms is actually not just the Lunar and Bright Life kits.

It also includes the CALMAP program, which is a pediatric consult behavioral health consultation service for primary care providers and other outpatient physicians so that they can get consultation from child psychiatrists and other licensed behavioral health practitioners so that they can keep patients in their clinical practice rather than automatically making a referral out to a licensed behavioral health provider.

Where we know there is a shortage of providers for those in person services that you're talking about.

We also know that we heard from children and youth before we launched Saluna and Bright Life Kids as well as since we've launched Saluna and BrightLife Kids, that without those digital programs they would not be able to access mental health support in their community for those face to face sessions that you're talking about.

And while that might be the best practice standard, we have shifted as a healthcare delivery system to telehealth for many behavioral health services.

And that's what Saluna and Bright Life Kids are providing telehealth services similar to many of the services that are provided in schools through telehealth programs that are operated by other statewide providers that are supporting school based services and supports.

While it may be better for people to get access to community based face to face services, many youth, many parents and caregivers don't know how to do that. They don't know how to access those services and supports. They're not aware that services are available in their communities.

And part of what we've built into the fabric of Saloona and Bright Life Kids is a care navigation component that allows users to get information about community based services and supports.

So part of the infrastructure that we've developed through these contracts is that they have a statewide network of affiliated providers, including school based providers, to be able to connect young people and their parents back to community based care when that's what they really need.

And without that kind of connection and care navigation support, many of these families, many of these children and youth would not otherwise be able to access care and support. That's what they are telling us. I'm not just telling you that. Right. Like that's what they've told us.

70% of the users that we surveyed for Saloon and Bright Life Kids, and that's 70% of the 195,000 people that are using the program say that this is their first touch point with the mental health system.

And through the care navigation, through the services and supports offered to these programs, they're getting access to support that they otherwise wouldn't have access to to. We're also simultaneously shoring up the fee schedule program, working with school districts and county offices.

But we have, like I said, made over $1.0 billion worth investments to school based services specifically and continue to support our leas and county offices to be able to stand up the infrastructure for the billing.

But it is a big change and it's, it takes time for them to and for us, for all of us as a system to implement these types of changes.

So I mean, but it is if it's $1.0 billion investment and this is $532 million in this area, that's half of the investment going there, right?

Sure. There was 532 million appropriated for the virtual services platform which includes Saluna, Brightlife, Kids, Calmap, some components of Calhope, other things are funded out of that, including contracts with youth serving organizations to provide input on the design of the programs as well as kind of other other investments. So it's not just the Lunar and brightlife kids.

And if you look at just those pieces on a year to year basis, it's a much smaller proportion. This is the total five year investment, not that, not an annual year to year investment.

And what so when you said earlier that there's no barriers to for schools to apply for reimbursement, is there? That's not what we heard at the last hearing. So something significantly changed between the last hearing and today.

I'm saying that for those nine LEAs that have submitted claims, including some of those who testified at the last hearing, they have submitted claims and have been paid for those claims. We don't control when they submit the next set of claims, but we're working with them to make sure that they can submit more claims.

Going back to July of 2024, they were testing the system, they're learning, right? So they're figuring this out at the same time that the program is rolling out.

And so they've submitted test claims, they've been paid, and now we're ready and able to pay for any additional claims that come in for those LEAs that have completed all of those onboarding steps. And we have about 29 LEAs, so it's not everybody.

There are others that are in various stages of readiness and my team has been working diligently with all of them to provide one on one support. Carillon Behavioral Health has representatives that are assigned to each LEA that's participating in the program. They have regular meetings with them. And there's a variety of reasons why some of the LEAs have not gotten to that stage.

But our goal is really to make sure that all of the Cohort 1 LEAs are able to submit claims by end of the school year and that all Cohort 2 and Cohort 3 LEAs are able to submit claims by the beginning of the next school year.

So we can start to see that volume of claims increase that are being paid through this program. But for those that are already a part of the program, have already submitted some claims, no, there's no barriers to them submitting additional claims all the way.

Back to July and are there. So do you anticipate that everyone who has had every school that has had expenditures that they are intend to get reimbursed for will be able to submit those claims in time to receive that reimbursement?

That's our goal is for Cohort 1, who can submit claims back to July of 2024 that we get all of them submitting claims by the end of the school year.

and that's, and the end of the school year is the deadline for them to be reimbursed for those services.

That would be a year past the date of service for any services provided on in July, but they would have actually a little longer than that for any services that were provided in October, for example, or November or December.

So the claiming timelines are really based on the date of service and then from there it kind of goes out. So any services provided today, for example, they have time to submit all of those claims.

But for any services that were July, August, September, we want to get all of those claims submitted by the end of the school year.

Okay. And on back onto the, the apps. Can you explain to me kind of what the. How you're evaluating them? I know you, you mentioned a couple things that, that it sounds like you've been able to survey or how does that evaluation process happen? What kind of oversight is over these programs and what does that look like?

Sure. So there's a formal evaluation of the Children and Youth Behavioral Health Initiative being conducted by Mathematica, a third party entity that was contracted by the California Health and Human Services Agency to conduct an evaluation. And they are working with each work stream. So they are looking at data from Saluna and BrightLife Kids.

They're also looking at data related to the fee schedule and all of the other programs that we oversee. So there will be a formal evaluation and the interim evaluation report is just what came out. We're also evaluating specifically the effectiveness of Bright Life Kids in Saluna.

And we have they report data directly to the Department and we evaluate those data regularly. We have weekly and monthly deep dive check ins with each of the vendors. We're reviewing all of their reports and deliverables. They're conducting surveys of their users to obtain feedback. They also utilize for those who they also utilize clinically validated assessment tools.

So part of what each of the vendors is looking at is improvement in the report of users related to the specific assessment tools that they're using.

So for example, with Bright Life Kids, they utilize the Pediatric Symptoms Checklist tool, which is a clinically validated tool to assess a young person's mental health at the time that they come to the Bright Life Kids program for services.

And then through the coaching program, they readminister, the Pediatric Symptoms Checklist, to evaluate whether the users are meeting their treatment goals or not. And so we look at all, they look very much at all of these outcome measures. Saluna does the same thing. And we also get reports on outcomes measures and data that we're seeing.

And so we are seeing improvements. We are seeing people achieving their treatment goals for the short term counseling services that they're getting. And separately, for example, like Saluna is working with Northwestern to conduct an independent evaluation of the services that are clinical outcomes provided through the Saluna app.

And we recently approved kind of their evaluation model for that. So there's all types of different ways in which we're evaluating these programs. But both Brightline, who operates the Bright Life Kids programs, and Couth operates the Saluna program, have a long history of providing digital behavioral health support to children, youth and families.

Couth has been in operation for over 20 years and they have peer reviewed research on their model and their clinical services model that they have been implementing both in the UK and now in the US Some of these evaluations that they're taking on in the US are specific to the services in California, for example, but they have a long history of providing similar services in the UK For Bright Line, they've been in operation for many years.

They also have peer reviewed journals and other data that show the effectiveness of the services and supports that they are providing.

And this is part of the reason why we chose these partners to launch these programs for us, because they do have the experience, they do have the outcomes to support their models and they're using evidence based strategies that are proven to work with children, youth and families.

So all of these evaluations and assessments, are they available to the Legislature and how and when do we get those? You want to take that?

Sure. So as evaluations are being completed, they are put in a place where the Legislature and the public can really have access to them.

On the broader initiative wide scale, we have so far produced forward a chart book which gives quantitative data that shows the outcomes to which we really want to hold ourselves accountable to across all 15 different objectives that we're trying to achieve through this initiative.

And then as has been referenced here, an interim evaluation has been been put forth. There's a number of additional products forthcoming throughout the next year and a half or so. And in addition to that, many of the different work streams have contracted with individual evaluation partners for additional, more focused evaluations on the work that's happening there.

And as soon as those are complete, they'll be put in a space where everyone can have access to them.

Thank you so much. We are going to move to public comment for any comment directed at the CYBHI. If you could keep your comments to a minute and if you're speaking on a previously stated position, please only provide name, organization and position.

Great. Good afternoon Chair Members. On behalf of behalf of Michael Saragosa, on behalf of the California Farm Worker Foundation, current Tulare, Current Kings Fresno and the Central Valley Latino Elected Officials Coalition, we support the continued funding of the Behavioral Health Virtual Services platform to ensure all children and young adults have access to behavioral health services regardless of where they live or their family schedule.

The farm workers we represent and the service workers we know they don't work traditional hours. We believe these platforms, these apps, give them the ability for their families, if we're young working adults, to be able to take advantage of services that they might not be able to otherwise.

We are particularly concerned about immigrant communities at their mental health when many families are living in fear of federal immigration efforts. We believe these programs are critical tools that are needed now more than ever to protect our most vulnerable youth and we urge the Legislature to prioritize these funds. Thank you.

Hello Chair Members. Omar Altamimi with the California Pan Ethnic Health Network. Again, CPAN has repeatedly raised concerns with DHCs about the Bright Life Kids and Saluna apps for which the state is paying more than half a billion.

In these times of fiscal uncertainty, we question whether it is a wise investment, particularly when we know that effectively reaching diverse children and families often requires in person support to have their needs met. We know that language access and culturally appropriate services through through these digital platforms continues to be a problem as well.

We believe that providing behavioral health services in schools is of critical importance for children and families of color and urge the Administration and Legislature to strengthen implementation of the fee schedule in order to ensure adjuate funding for school based services. Thank you.

Kelly Larue with Resilient Advocacy on behalf of Hazel Health. We are proud to offer behavioral health services via Telehealth to about 1.6 million school kids with no co pay or deductible no matter their insurance.

We appreciate the initial investments made by the Legislature and the Administration but want to flag the time and work still necessary to fully stand up the sustainable funding source the Multipayer Fee schedule.

As we heard from LAUSD in Fresno a couple weeks ago and in the recently released Mathematica assessment, the fee schedule is not fully ready and mature claims are not expected until the end of calendar year 2025.

We appreciate the initial collaboration with DHCS, but that doesn't negate the school districts who may not be fully ready to be integrated into the fee schedule who do want to continue providing some sort of services in school and we are helping them through the onboarding process. We look forward to the continued collaboration with the Legislature and the Administration. Thank you.

Good afternoon, Chair Members Jorge Cruz representing the California Behavioral Health Association. First, we strongly support the continued investment in the Behavioral Health Continuum Infrastructure Program and urge the Legislature to ensure transparency and accountability and bond implementations for equitable distribution.

Second, we appreciate the Children and Youth Behavioral Health Initiative rollout and as the state struggles with ongoing behavioral health crisis, continuing funding is essential to reduce disparities. Third, we urge the Legislature to prioritize long term funding and alignment for the Behavioral Health Program BRIDGE Housing Program.

The program is key for comprehensive behavioral health response and finally, we urge the Legislature to prioritize the investment proposed as part of BH Connect and strengthen our workforce, housing and comprehensive support in alignment with broader goals of Cal aim and we remain committed with working with this body. Thank you so much.

Good afternoon Madam Chair and Committee Members. My name is Anthony Butler-Torrez with the California Hispanic Chambers of Commerce and we are in support of this initiative. Thank you.

Thank you. Seeing no other public comment, we will move to issue 5, BHConnect and the MEDI Cal Waiver. For this issue. We are asking the Administration to provide an overview of BH Connect and its major components, as well as provide an update on the funding plan and study status of implementation.

You do have background for this issue on page 26 of the Agenda and if you could keep your testimony to five minutes, please go ahead and introduce yourself and begin when you're ready.

Good afternoon, this is Paula Wilhelm, I'm the Deputy Director for Behavioral Health with Department of Healthcare Services.

So as you may know, the Behavioral Health Community Based Organized Networks of Equitable Care and treatment initiative or BHConnect, is a package of policies designed to strengthen and increase access to the continuum of community based behavioral health services for Medi Cal Members living with significant behavioral health needs.

As outlined in the Committee's agenda, BHCONNECT includes multiple components so several components require Medicaid Section 1115 demonstration waiver authority, while others will be implemented under California's Medicaid State Plan or other state authorities. DHCS received critical federal approvals for BHConnect in December of 2024.

Following federal approval, DHCS has been working to develop a detailed multi year funding plan that captures projected expenditures of state, local and federal funds. We anticipate being able to share this additional detail on the spending plan as part of the May revision.

This plan will include annualized breakdowns of costs and funding sources across all years of the demonstration. The Committee also asked about the projected total General Fund obligation over the five year demonstration period.

One thing we wanted to call out is that the amounts currently included in in our BH Connect waiver terms and conditions are expenditure authorities or limits and do not necessarily reflect actual projected expenditures.

And so our budget projections, including projections of General Fund obligations are part of that multi year funding plan that I just mentioned that we plan to provide as part of the May revision. I will mention.

In General, consistent with Proposition 30, we expect to use General funds to support the non federal share of statewide mandatory components for all counties such as activity funds for children and youth involved in the child welfare system and then county funds will support the non federal share of components that counties may opt to provide and that includes community transition in reach services, our adult evidence based practices, and the opportunity for counties to receive federal financial participation for short term stays in institutions for mental Diseases or IMDs.

In addition, a couple more funding notes the workforce initiative, which is authorized for a total of 1.9 billion over five years, is supported by Behavioral Health Services act funds 142.5 million over five years and an approved funding mechanism that allows California to count and claim federal funds on state dollars that it otherwise would have spent on designated state health programs.

And then transitional rental assistance, which was also approved under BH Connect, will be provided by Medi Cal managed care plans rather than county behavioral health agencies and so rental assistance will be funded with a combination of General funds and federal funds.

Shifting gears a little to provide an implementation Update Implementation of BHConnect is currently underway and key components will go live between now, Spring 2025 and July 2026.

DHCS has been collaborating actively with county behavioral health agencies, Medi Cal managed care plans and other stakeholders to develop policy guidance and we have released several pieces of guidance in draft for stakeholder feedback.

So you will see several BH Connect components implemented between now and July 1st of this year and these include the Access Reform and Outcomes Incentive Program. That program will make up to $1.9 billion available to reward behavioral health plans for improved performance on quality metrics.

DHCS released guidance on the incentive program requirements for participating behavioral health plans on March 10th of this year and we wanted to share that all 45 counties that are eligible to participate in the program have submitted letters of commitment indicating they do intend to pursue those incentive payments and Those counties cover 90% of Medi Cal Members.

Beginning this month in April, counties will also have the option to begin to cover new community based states evidence based practices for adults in Medi Cal and these include highly effective models like assertive community Treatment, coordinated specialty care for first episode psychosis and supported employment services.

Counties that commit to implementing new evidence based practices and also meeting an array of quality milestones may choose to take up the opportunity to receive federal financial participation for short term stays in IMDs. We note that payments to behavioral health plans for these services must be reinvested in care for Medi Cal Members with behavioral health needs.

DHCS anticipates releasing final guidance for the IMD opportunity and the coverage of the adult evidence based practices that I just mentioned within the next two weeks and counties may begin to implement those services on a rolling basis after our guidance is published.

Preliminary survey data from counties has indicated strong interest in these new optional evidence based practices, so counties have reported to us that 35 counties plan to implement at least one of the new optional benefits for adults and this would enhance coverage for 85% of Medi Cal Members Also by this July, we plan to publish guidance to update existing coverage for several evidence based practices for children and youth to to improve and expand the delivery of those practices.

To support this implementation of new or expanded services for children and adults, DHCS is also currently working to contract with Centers of Excellence and the Centers of Excellence will serve as technical assistance hubs to support counties and behavioral health providers as they implement evidence based practices with high fidelity.

Next, you'll see a second wave of BHConnect components rolling out between July and December of this year. And so during that period we will launch two initiatives to support child welfare involved Youth Activity Funds for Strengths Building and Wellness and Joint Specialty Mental Health and Child Welfare home visits.

After beginning in July and then thereafter, Medi Cal managed care plans will also have the option to begin covering transitional rent assistance.

So they will have an option to launch coverage in July and then mandatory coverage for eligible Members with behavioral health needs will take effect in January 2026 and then coverage for some of the other populations that are eligible for transitional rental assistance will be phased in after January of 2026.

In addition, want to acknowledge we are actively partnering with our sister agency, the Department of Healthcare Access and Information or HCAI to implement the BHConnect workforce initiative. The workforce initiative includes five distinct behavioral health workforce development programs.

Those will also be phased in with the loan repayment program, likely the first of the five programs programs that DHCS and HCAI plan to launch in July or after finally bringing us into 2026. By January of 2026, counties will have the option to implement community transition in reach services.

This is a service to support adults who are returning to the community after long term stays in inpatient, subacute or residential facilities. And Then also in January 2026 we we anticipate releasing updated coverage requirements for high fidelity wraparound services for youth in Medi Cal and implementation of that high fidelity wraparound guidance will follow in July 2026.

So as you can tell from the flyover, we are very excited about these multiple opportunities to offer new services and supports for our Medi Cal Members and happy to help with any questions from the Committee. Thank you.

Any other comments? No. Okay, thank you. Could you go over again? I know you mentioned information you're going to share before may revise or as part of may revise. Could you go over that in a little bit more depth?

Yeah. And start with maybe a point of clarification which is the timing was such that the information available in the November Medi Cal estimates had to be submitted before we actually received federal approval for BHConnect. And so the November estimates don't reflect the final approved waiver package.

So now that we have that approval, we are working on updates to the estimates as part of the May revision.

And then to accompany and sort of further explain those estimates which you're aware are at a higher level, we're working on a multi year spending plan that will sort of further break down down the different components within BHconnect and for each component, the share of federal, state or county funds.

And then we have had so many conversations around housing and transitional housing and short term rental support. And so now the waiver, you know, we have the waiver for these things, but are the health points plans ready?

Can you talk about readiness to be able to use these to administer short term rental assistance via the Medi Cal waiver? And what happens if health plans aren't ready? How do we make sure people get this support?

Yeah, thank you for that question. And being able to cover rental assistance through Medi Cal is brand new. And so we have been engaging intensively with Medi Cal managed care plans on the proposed guidance and parameters for the program, including the approach to rates and reimbursement and also some of the policy parameters I should mention.

Coverage is available for up to six months for Members who meet special specified eligibility criteria that have already been approved at the federal level. But beyond that, to your point, there's a lot of great questions about how we make sure we're reaching that eligible population.

And then once someone has been identified, how quickly can they be referred to the plan, connected with a housing provider and connected to an appropriate housing setting. We did release a concept paper last, I want to say it was last fall and got some really great feedback from the field about how to make this benefit more feasible.

And so we've been building on that and anticipate releasing some of our final guidance for plans this month in April, which will give them a little bit of Runway before July's optional coverage implementation. The last thing I will mention is that they do a couple things.

The plans will be submitting what we refer to as plans of care to describe how they're going to offer transitional rent, which is a community support. And we've been looking really carefully at how plans experience with other community supports, including community supports that specifically focus on housing.

So housing transition and navigation, housing tenancy supports, managed care plans have already been providing those. So we want to look at how they and their network providers are offering those services, connecting with those eligible populations and apply that knowledge to implementation of the transitional rent benefit.

Thank you for that. Across many of these hearings, we've heard about phenomenal programs that state somewhere it gets bogged down. I think we just heard about it in the schools on the last issue where we put these amazing programs in place. There's funding, there's waivers, there's all the statutory things that are needed.

And then somehow this money just doesn't get to the folks that are in need. So I think it's critically important in this in particular, the Legislature has had numerous conversations around how we keep people housed, how we get people.

We know that short term rental assistance is one of those things that obviously prevents homelessness instead of trying to fix it after it happens.

And so just critically important that we're able as a state to follow through, to get the money out the door to make sure people in need actually get what we have gone out and told them. We've made a lot of promises that we're going to do these things.

And so I'm personally anxious with anybody who comes, comes to testify, I'm anxious for us to get going. Whether it's this program or, you know, last hearings program or a program from two hearings ago, we just keep hearing the same message.

So I hope on the front end we're really acting with urgency to make sure that rental assistance can go as soon as we're statutorily like ready for it to go. Any questions? Assemblymember Bonta?

Yeah, thank you, Chair. I know that we have this amazing program, BHConnect, along with BHSA and CYBHI and more, and that they're hugely kind of interwoven together initiatives that to some extent rely on each other to be successful. How is DHCS holistically ensuring that level of integration that doesn't impact one initiative from being fully implemented?

And do we have any flexibility along the way to course correct in one initiative if necessary without upsetting the entirety or another in some way?

Yeah, thank you for the question. And I think you said it at the top. From our perspective, these initiatives are complementary and interwoven and really driving toward the same goals and in many cases focused on improving care for the same populations.

And that includes people with particularly significant behavioral health needs, children and youth, but particularly system involved children and youth, people experiencing homelessness, justice involved individuals.

And so we have been working carefully to, you know, identify those pieces of the policy that are meant to work together and make sure we address those intersections and work with stakeholders on how to, to the point of the previous question, make it work on the ground when we roll it out and I'll share a couple of examples if I can.

In BHConnect, we are implementing new coverage for evidence based practices. Some of those are evidence based practices that were called out in the Behavioral Health Services act statute as practices we expect to see all counties using. That includes assertive community treatment for the full service partnership population and coordinated services specialty care as a form of early intervention.

And so we, through Medi Cal want to lift up a payment model that will support high fidelity delivery of those services which we are requiring on the BHSA side. And then to sort of support implementation, we're utilizing the Centers of excellence so that there's robust Ta and technical assistance. Sorry for the acronym.

The other thing I'd love to mention that I realized I didn't in relation to transitional rental assistance is for transitional rental assistance under MEDI Cal it is limited to six months and during that six months we want to work on developing sustainable housing plans for the individuals who are receiving rental assistance for the population with behavioral health needs.

Those housing supports may be provided and financed through the Behavioral Health Services Act.

And so in addition to the engagement we've done with Medi Cal managed care plans on how to implement the rental assistance benefit, we've been proposing and sort of workshopping policies on how managed care plans will collaborate with county behavioral health to provide coordinated care and effectively handoffs when a individual with behavioral health needs exhaust their rental assistant benefits but may still need other supports that can be wrapped around them from the bhsa.

So there's all kinds of intersections. I'll try not to go on and on, but let me know if I can share more about.

All right. With that we'll say thank you and open up for public comment. If you have comment directed toward BHConnect, please keep your comment under one minute.

Good afternoon, esteemed chair and Committee. I am here Elle Grant, on behalf of the California Alliance of Child and Family Services or the California alliance, which represents 165 community based organizations that serve our state's most vulnerable children, youth and families, especially those who are at risk of exposure to the child welfare system.

And we're incredibly supportive of the goals of BH Connect and are very happy about the opportunity for transitional rental assistance through Medi Cal as well as the upcoming high fidelity wraparound services for youth.

We appreciate the Committee's attention to this matter and want to reiterate the need to lean on CBOs to ensure implementation that reaches the Families of highest need. Thank you.

Well, thank you to our panelists. We're going to move on to issue six, the Commission for Behavioral Health. You have background on page 29 of your agenda. And this Commission underwent several changes since the passage of Proposition 1. And we're asking the Commission to provide an overview of the Commission transition work under Prop.

1, as well as provide an update on its various activity, including the Innovation Partnership Fund. For this panel, we welcome interim Executive Director Will Lightbourne and representatives for the Department of Finance and the LAO. And if you could limit your testimony to five minutes, you're welcome to introduce yourself and start when you're ready.

Thank you. Chair Addis Members Will Lightbourne as introduced. I want to thank the staff for the background paper. Prior to Proposition 1, the Commission's responsibility, a major part of it, was to review the county innovation plans that were being submitted individually.

These funds continue to be available until they're, you know, have to be encumbered by the end of June 2026. And until that occurs, the Commission is still responsible for working with the counties on these. Last month we reviewed, I think, six innovation plans from three counties. This April, we're going to look at plans from another six counties.

So this continues and we expect the pace of this to pick up so that counties realize that if they don't, encumber funds will revert in June 2026. Commission is also responsible to review the county integrated plans under Prop . 1.

And in some respects this is sort of an expanded role as these will also now include the non BHSF behavioral health funding in the counties.

While the approval responsibility will be with dhcs, I anticipate that the Commission will both reflect to DHCS our input from the reviews as well as from the constituencies that we work with and our community contractors.

The Commission remains responsible for the initiatives under the Mental Health Wellness act, the funding and evaluation of the Behavioral Health Student Services act, the evaluation of full service partnerships, the implementation of the Empath Crisis Stabilization Units, the implementation of the All Cove youth drop in Centers, and the Community empowerment contracts with nine specific underserved populations.

Starting in 2026. We also become responsible for the Innovation Partnership Fund Fund. Proposition 1 expanded the Commission from 16 to 27 Members with new seats for people with lived experience of SUD and mental health illnesses, family Members of people with sud, people with aging disability background, youth, veterans, and people knowledgeable of community defined evidence practices.

Most of these have already been appointed and in addition, the legislation allowed the Legislature to appoint representatives, delegates for the legislators if they are unable to attend, and we're grateful to both the speaker and the pro tem for very timely appointments.

The Commission has approved creation of working committees in the areas of budget, program policy and advocacy, and legislation, and we expect those to start functioning in spring.

Because of the changed roles and especially the need to support historically underserved communities, we have refocused sort of the structure of our departmental staffing and particularly in preparation for the Innovation Partnership Fund.

Still underway as part of the Prop 1 transition is the onboarding and orientation of new commissioners, institutionalizing the Commission's renewed commitment to transparency, working with our advocacy and community empowerment contractors to focus on the Behavioral Health Services act, and increasing our evaluation focus on critical programs.

The expansion of BHSA to SUD is of enormous importance and reflects the reality of the pathways of many people who start whose condition starts in one area and their circumstances change and deteriorate until they're in more acute need. For us, this is more than a rebranding or change in vocabulary.

It really sort of is requiring us to look at all of our activities, our projects and initiatives, both ongoing and future, in terms of really fully embedding the dimensions of SUD services to sort of get to that point.

We're counting both on our community partners, our public commentators, and particularly our commissioners with background in the area to sort of help lead that integration. Data reporting will remain a core part of our work and we envision expansion of this into three dimensions.

As in the past, financial transparency and reporting on revenues and spending is something that we think is a enormous value and stakeholder organizations have made very clear that they really want us to continue that.

Second is to make available to the public critical information about county integrated plans and the updates as those occur, and then to really sort of work to develop the county and state level population wellness data that we can integrate with the data we get from Department of Healthcare Services, Healthcare Access Information, cdph, edd, Department of Justice and the Department of Education.

We really are sort of the data warehouse where all of that comes together. So to display trends and possible correlations between implementation of many of the new services that we've been talking about here today.

And you know, what are the results both in public health conditions, but also in social health conditions such as education, employment, homelessness and involvement with the carceral system. As we look to the future, we are committed to supporting the Innovation Partnership Fund that ensures California meets the moment.

It was created of course in statute to improve BHSA programs and practices and meet statewide BHSA goals, particularly with underserved populations and historically frankly oppressed populations. Our expectation is that, well, statute provides that the eligible grantees include private, public and nonprofit partners.

And in the process of implementation we're required to would anyway be consulting with agency with DHCS, with CDPH and HCI and then we'll start reporting to the Legislature in 2030 and every three years thereafter.

Members of the Commission who have particular interest innovation have been exploring possibilities or scenarios primarily with academic institutions that focus on aspects of neuroscience. But this is not in any way a finalized concept. This is an interest that was shared at the February Commission meeting.

We've issued a call for concepts broadly to our stakeholder stakeholder lists across the state. We're being very clear that this is not a solicitation of proposals.

Rather it's simply what are the areas that you hope the innovation Fund will address and whether that's and when I say addressed to really produce systemic change in the behavioral health goals of Proposition one and whether that's access workforce development practice, SUD integration, automation of non treatment business practices and elevation of community defined evidence practices.

We are expecting to get these concept responses back by mid April and then we'll be reporting those to the April Commission meeting with the expectation probably of a May meeting.

Really diving in deep to look at how does the Commission want to engage with all of our partners to vet and prioritize and develop sort of implementation strategies for whatever the goals that are settled on are.

I know I speak for our chair when I say these will be competitive procurements and we will be requiring putative partners, whether philanthropy or private investors, to confirm their participation and investment commitments. In other words, we will be looking for bankable assurances from anyone who is offering partnership in this.

We recognize that there are existing public private partnerships from which we can learn and we'll be doing that over the months ahead.

So with that, let me simply say how much we look forward to partnering with our cousin departments and agencies with the implementation of BHConnect, which is a thrilling completion of a lot of people's dreams and goals, but also all of the components of bhsa. So thank you very much.

Anything else from either of you two? No. All right, thank you. I do have questions on the Partnership Fund and sort of along the same lines for the last issue. The 20 million starts in 2026. Right. So and then.

But reporting doesn't come to the Legislature, I think you said until 2030 as that we said so a long time in there. And my hope is that right now we can have the conversation that in 2030 we're not going to be saying what happened to this money? Why didn't it get out the door?

And so I'm just, you know, wondering about your timeline, your criteria, your guidelines to make sure that when this money becomes available, it actually starts to, it starts to, to flow to the projects that need it. And I will say that with inflation what it is, that $20 million, if it waits till 2030, is not going to be the same 20 million.

So I think the Commission is really determined to be sure that we're ready to start implementing July 1, 2026. And even though there are 16 or 17 months between here and there's, that's a brief period of time when you actually live through it.

So that's why we've sort of started the process already and really look to the sort of May meeting as a sort of point where we can start focusing and saying which concept do we really want to pursue and then what's the implementation process for that and who do we engage as partners to work with us?

Thank you. Any questions from Members? Yep, Assemblymember Bonta

Just a quick one for kind of context. So the Commission renamed. How much grant making would the Commission do outside of the 20 million?

Well, we are responsible still for the Mental Health Wellness Act, which is an additional 20 million a year. The Behavioral Health Services and Supports act, we have out there. Right. Continuing contracts totaling about $280 million. The funding for those funds are to be expended by 2028.

And we have funding for the evaluation of, of the BHSSA and with the intention of sort of sharing the lessons learned with our colleagues at the other departments who are also working on school based mental health approaches.

Then beyond that, we currently have contract about $30 million in contracts for empath crisis units that I believe to 10 hospitals. We have another 20 or 30 million out for crisis support centers for first episode psychosis in a number of counties. And then additionally we have full service partnership ongoing responsibilities for evaluation and report to the Legislature.

And then we have about 20 sort of one time contracts that are in one or another stage at this point that we will sort of continue to work with. Thank you.

Any other question? Seeing no other questions, we'll open to public comment on this item if there's anyone with public comment, the Commission on Behavioral Health. And if you could keep your comment to one minute or less.

Hi, Elle Grant on behalf of the California Alliance of Child and Family Services. Many community based organizations believe that thoughtful inclusive planning is essential to ensure the Innovation Partnership Fund leads to real, lasting impact. We strongly recommend that the Commission present a clear process and timeline for developing the Fund at the April or May 202025 meetings.

It's critical that community stakeholders, especially from underserved and Low income populations, are involved in every stage. And Proposition One makes it clear that this Fund is meant to serve those most impacted behavioral health disparities. The process must be open and transparent.

While Commissioners have decision making authority, we need honest public dialogue before decisions are made and explanations when community backed recommendations are not adopted. The Commission has a powerful opportunity to center culturally rooted ideas and build public trust. Let's not miss that chance. Thank you.

Good evening board Members or chair Members. Sorry. We support the Commission's recent efforts to more meaningfully engage stakeholders and to align the transition with improved governance, transparency and accountability. And we look forward to continued engagement. Thank you.

I just wanted to clarify if there's going to be a public comment for General okay.

Seeing no other public comment, we'll say thank you to these panelists. We appreciate you and we will open to public comment for items not on the agenda. So we will now entertain any public comment for any items that weren't covered on today's agenda. And if you could please keep your comments to a minute or less.

Good evening Chair and distinguished Assembly Members. My name is Michael Tsingiras. I'm a licensed clinical psychologist and I represent a consortium of integrated behavioral health psychologists throughout the state. And I also train people in integrated behavioral healthcare in three residency programs with John Muir Health, Lifelong Medical and Contra Costa County Medical Residency.

And I'm here to sound an alarm on the collapse of California Psychological Workforce Pipeline. This year, more than 528 doctoral psychology students nationally, more than double last year, did not match with an internship site and this is vital for people completion and licensure.

These closures are due to financial instability, shutting down programs and gutting some of the HRSA funds, while there are investments in stipend and loan repayment, which we are extremely grateful for and honor this Committee for in huge ways. Thank you. If we don't have the internship programs, if they shutter, stipends don't matter because we lose the pipeline.

So we're asking for two things. One is emergency bridge funding to protect existing internship programs. Right now my school could use them, the University we partner with. And the second is some dedicated long term funding that helps recreate what the Federal Government likely may not do to protect psychology internships.

It's a small amount of money with a huge amount of impact. We in California need to lean in right now and are extremely grateful for this Committee's work and your leadership.

I'll be sending a letter from our behavioral health group and and this next week with a few policy suggestions and really grateful and honor for this Committee and honor your work. Thank you.

Good afternoon, Chair Members. My name is Michelle Gibbons. I'm with the County Health Executives Association of California representing local health departments across the state. I honestly just wanted to come and thank you for your comments around the federal impacts.

It has been a tough week for the public health community writ large, but for local health departments as well.

They're having conversations and scrambling and hoping that, you know, the funds will stay with them, but also acknowledging that there's a lot of work to do to Fund public health on a continuous basis and a lot of fear about the the starting and stopping of funding public health.

So I just want to thank you for acknowledging the impacts and acknowledging how vital the public health infrastructure is. And also as a moment just to say thank you, Assembly Member Banta, for your acknowledgments last week for Public Health Week, too. They truly are ready to do great work. They already are.

They have protected our communities day in and day out from a vast array of communicable diseases, some of some of the ones that make the news and also the ones that folks never, ever hear about. But it's vital, you know, and we just ask that you continue to protect public health because it protects you. Thank you.

Good afternoon. Diana Luna with CBHDA, representing County Behavioral Health Directors Association for all county behavioral health directors across 58 counties, wanting to comment on SB525 supporting county behavioral health facilities.

So while the Governor's Budget addresses a mechanism for physical health facilities to support the increased minimum wage Pursuant to SB525, the budget does not include proposed funding to support these increases for impact behavioral health facilities. CBHDA strongly urges the Legislature to consider funding implementation to support these increases. Minimum wages in behavioral health facilities consistent with the intent of SB 525. Thank you.

Seeing no other public comment, no other comments from the Members. We will adjourn this hearing. Thank you so much.