Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services

Good morning, everyone. Happy last day of April. In our subcommittee today, we're gonna be going over three different topics. Department of State Hospital, Commission on Behavioral Health, and Department of Health Care Services. We can get started with our first department, DSH. I've heard it's been called. Can come on up. Hi. Nice to see you again.

Stephanie Clendenin, Director of Department of State Hospitals. And I'm joined by Chris Edens, our Chief Deputy Director of Program Services. I'll start off by providing a brief overview of the department, its budget, and provide a high level summary of our case load updates for the patient driven OE&E item and the incompetent to stand trial solutions item.

And then I'll turn it over to Chief Deputy Director Edens to provide the updates on CONREP Non-SVP and answer the question in the agenda regarding the LPS allocation methodology. The Department of State Hospitals manages the California State Hospital System.

Our mission is to provide evaluation and treatment in a safe and responsible manner by leading innovation and excellence across a continuum of care and settings. We operate the five State Hospitals located throughout California with inpatient beds that include acute, intermediate, and skilled nursing facility levels.

We have a conditional release program by which we, which are a system of community based services that are operated in partnership with county behavioral health departments and private providers that is designed to transition patients back into the community following a forensic commitment to DSH.

And we also have partnerships with county behavioral health programs, private providers, and county sheriffs to provide community based restoration, diversion opportunities, and jail based treatment programs for individuals committed to the department as incompetent to stand trial.

The individuals served by our system are mandated for mental health treatment by either a criminal or civil court judge or the Board of Parole hearings. And the majority of individuals we serve are forensic commitments.

They have either committed or been accused of committing crimes linked to their mental illness and come to us directly through the criminal courts or after they have completed a sentence at the California Department of Corrections and Rehabilitation.

This includes individuals that are committed to the department as incompetent to stand trial, not guilty by reason of insanity, offender with mental health disorders, and sexually violent predators. We also serve incarcerated persons from CDCR who need inpatient mental health services. That's the Coleman patients.

And lastly, we serve individuals conserved by a civil court under the Lanterman-Petris-Short Act. With respect to the department's budget, the proposed budget for fiscal year 26-27 totals 3.2 billion including state operations and capital outlay, which represents a decrease of 34.1 million or 1% from the 2025 Budget Act. The proposed budget includes four permanent positions and two one year limited term positions in budget year.

The decrease in funding is primarily attributed to IST solution savings, and the new positions are to address dental workload and implementation of SB 380, a transitional housing study. As it relates to our case load estimates, the department is projecting a census of 8,317 by the end of fiscal year and 8,427 across its programs by the end of fiscal year 26-2027.

The increase is primarily related to expected increases in community based restoration and diversion placements for individuals deemed incompetent to stand trial. For the case load update related to patient driven operating expenses and equipment, the Budget Act of 2019 adopted a standardized methodology to provide funding for patient related OE&E items based on updated census estimates for each fiscal year and an estimated per patient cost derived from past year actual expenditures.

Due to rising cost, DSH request 19 million in fiscal year 25-26 and 19.6 million in 26-27 and ongoing for increases in cost of utilities, pharmaceuticals, foodstuffs, and outside hospitalization. We are seeing higher costs due to inflation, particularly in the areas of outside hospitalization and pharmaceuticals, and the higher cost in the budget years due to a higher projected case load census. Moving on to incompetent to stand trial solutions.

As of the governor's budget, the department projects a one time savings of 114 million in 23-24, 117.8 million in current year, and 94.2 million in budget year. The 23-24 projected savings is related to counties who have not yet progressed with their IST infrastructure project.

DSH is proposing to revert any obligated funding in this program. This funding was originally appropriated in fiscal year 23-24 with five year encumbrance authority to provide grants to counties to develop additional housing to support incompetent to stand trial individuals receiving services through diversion or community based restoration.

The projected current year and budget year savings are primarily a result of updated phased in activations of DSH diversion and community based restoration programs and programs serving lower census levels than the maximum budget the program is projected to support. The agenda asks that we provide an update on the progress made in meeting court orders in the Stiavetti v. Clendenin case and the impact of recent policy changes, including SB 1323 and Prop 36.

As it relates to Stiavetti, to provide some background, as a result of the department experiencing significant year over year growth and referrals of individuals deemed incompetent to stand trial that exceeded the department's ability to create sufficient additional capacity, the department experienced increasing wait list and times for restoration of competency services.

In 2015, the ACLU filed a lawsuit focused on the time that IST defendants were waiting in jail to be transferred to DSH's inpatient programs. And ultimately, the court ordered the department to in initiate substantive treatment services within 28 days for IST defendants.

The court set an initial deadline for the department to achieve the 28 days and also set interim benchmarks for the department to achieve towards meeting that 28 day deadline. They then, the court then revised the initial deadline and benchmarks in the fall of 2023 due to the impacts of the pandemic on our system.

And ultimately, court required the department to achieve 28 days by March 1, 2025, with interim benchmarks to achieve 60 days by March 1, 2024, 45 days on March 1, 2024, and 33 days in November 2024. The 2022 Budget Act included a significant investment towards additional IST solutions.

These solutions, along with other investments in prior budgets acts, included short term and long term strategies centered around two primary goals. The first being to initiate treatment services for IST individuals within 28 days as required by the court.

And the second was increasing community based treatment and diversion options with the goal of reducing criminalization for individuals with serious mental illness. As a result of the rapid implementation of IST solutions, easing of the pandemic impacts on our facilities, and other efforts.

The department has seen substantial decrease in both the IST wait list and wait times and met all of the court's ordered benchmarks and continues to provide timely access to services for individuals found incompetent to stand trial within 28 days.

And to provide a measure of that progress, during the pandemic in January 2022, we had reached an all time high of 1,953 IST individuals on the pending placement list, with the individuals averaging over 140 days to treatment.

At the April this year, we had only 250 individuals on that pending placement list. 250 individuals represents significantly less than one month's worth of referrals. As of this fiscal year, we're receiving an average of 405 referrals per month. The average time to initiate treatment for IST individuals in March was around 5 days.

With respect to the impacts of SB 1323 and Prop 36, Prop 36 provides for specified drug and retail crimes that previously were charged as misdemeanors to be charged as treatment mandated felonies or receive increased sentences. This increases the range of crimes for which someone may be found incompetent to stand trial on felony charges and referred to DSH programs for treatment.

Therefore, it may increase referrals to DSH. However, the number of individuals referred to DSH for treatment may be offset by the application of SB 1323. Don't really need to tell you, Chair, about this bill, but I will provide a little highlight on it.

SB 1323 became effective January 1, 2025. It included amendments to modernize the IST process by providing judges the authority to determine if restoration of competency is in the interest of justice. And if not, to provide longer term more comprehensive treatment options with the emphasis on mental health diversion.

Under SB 1323, when a court finds restoration is not in the interest of justice, the court must conduct an eligibility hearing within 30 days to determine if the individual is eligible for placement into a diversion program.

And if not eligible to be granted to diversion, the court may consider a referral to the public guardian for conservatorship investigation, assisted outpatient treatment, CARE court, or may reinstate competency proceedings. This provides an earlier pathway intended to divert eligible individuals into community based treatment when appropriate rather than referring to inpatient restoration of competency treatment at DSH.

So we continue to monitor our IST referral rates and the potential impact of both Proposition 36 and SB 1323. But overall to date, for fiscal year, fiscal, for this fiscal year, the department is experiencing a small reduction in referrals compared to last fiscal year.

During the first eight months of fiscal year 26-27, we received an average of 405 IST referrals per month compared to an average referral last year of 451 per month. So I'll now turn it over to Chief Deputy Director Edens to cover the remaining items.

Good morning. Chris Edens, Chief Deputy Director for Program Services at the department. I will be covering the conditional release program non SVP, caseload item. The department proposes 2.1 million in budget year and ongoing in response to cost increases to maintain program operations at our Golden Legacy Step Down Program.

Of this amount, 1.8 million supports base rate increases governed by the Department of Health Care Services, which include the IMD rate and the quality assurance fee rate. These rates both support the program's licensure.

The rate increases by 3.5% annually and covers basic expenses to operate in IMD and has not been updated within our DSH contract since 2022. In addition to these base rate increases, 300,000 will be used to support essential psychiatry services required to meet program standards.

The current funding level for the contracted provider is insufficient to support a full time psychiatrist. And during a recent oversight visit, we identified that the provider was unable to meet our treatment standards due to the gap in the psychiatry coverage.

In addition, we have realized one time current year savings of $4.5 million resulting from the closure of the CONREP FACT regional program here in Sacramento. And the delayed activation of a new Central California FACT program that will replace our program that we've lost here in Sacramento.

But due to that delay, we are proposing to redirect these savings one time to support 1.6 million in current year costs related to the increased bed rates at our Golden Legacy Program and apply the remaining 2.9 million to offset overall CONREP provider cost increases.

That concludes that item. And I will move on to the question, the last question that's in the agenda, with regard to an implementation update on the new system for allocating beds to counties for the LPS and IST non restorable and maximum term populations.

So just by way of background, statutory authority allows the counties to contract with the Department of State Hospitals for the treatment of LPS patients. The department is one of the various treatment options available to counties for LPS patients. We work with CalMHSA, who collaborates with each county to develop and negotiate an MOU, which governs the service of our LPS patients within the system.

And the this MOU also references the number of beds that are made available to counties, as well as the bed rates that are charged. Prior to July 1, 2025, the total number of State Hospital beds available to counties was 556.

At that time, there was no set allocation per county. And LPS admission was offered essentially in first come, first referred basis. Counties then reimbursed the department for actual usage of a State Hospital bed based on our negotiated daily bed rate.

However, as of July 1 of, the department as well as CalMHSA collaborated with counties to transition to a new county by county bed allocation model, which addresses several issues that were raised with the former process. It allows counties to manage the utilization of their allocated beds.

And provides the opportunity to maximize the use of the State Hospital LPS beds for those who are in need of the highest level of care. To support the counties with this transition, we established a centralized patient management team dedicated to this effort. We also implemented a SharePoint site that enables the county's real time information and access to their referrals, census, other tools, and resources.

We also standardized and streamlined forms to create efficiencies in the administrative process to help minimize the number of unused bed days. And also during the initial implementation of the new process, the department, as well as CalMHSA, hosted regular open office hours to provide technical assistance to the counties.

Overall, we've received a lot of positive feedback from the counties transitioning to the county bed allocation model. Last year, as I mentioned, historically, we had been making available a total of 556 beds. Last year, we increased this by 25.

And, more recently, in late January, early February, we increased the LPS capacity by an additional 44 beds. And so we have been working with counties to try to fill those additional 44 beds. Pause there and see if there are any questions.

Okay. Department of Finance, you have anything to add? Will? Great. Thank you. Director, can we go back to on number three when you're explaining just an update on the Prop 36 and SB 1323. Did you mention, one of the last things you gave numbers on like the increase from 400 about 441 per month in court referrals. Is that because of Prop 36? Is that why that's the increase?

Actually, we've had a reduction. So. Yes. And SB 1323 is winning out. Okay. So, so last year, we saw 451 referrals. This year, we're seeing 400.

Okay. But is it just kinda like carrying out to a status quo status quo because of Prop 36 and 1323. So it's 1323, the intent was to minimize but not because of Prop 36. Is it fighting against that intent?

I don't know that we see that. I think we are definitely seeing individuals going through the SB 1323 process. But we also, on the natural, see some counties increase over time, you know, the different things that happen that cause numbers to increase and fluctuate within counties.

So overall, it we definitely are seeing SB 1323 place people going through the SB 1323 pathway. But overall, we don't normally see a large number of those types of crimes within our commitment population where that's the primary crime coming to DSH. So we're not necessarily seeing a significant increase in Prop 36.

Good to hear. Thank you so much. And then on the background you gave around the operating expenses, you mentioned the outside hospitalization for the patients. You talked about pharmaceuticals and just the increase. Can you share a little bit more and expand?

And I know we reached out to the department on this issue. And back in, I think it was like 2025, there's a report that anticipated the increase in expenses for outside hospitalization. But the current increase of about 22% exceeds the previous anticipation. What can be done in our control to minimize that huge increase in cost for outside hospitalization?

Thank you for the question. Some of the cost increase is driven from not only inflation, but we also have an aging population within the State Hospitals. And so that is partly what is driving as individuals age. There have increased costs for medical service and medical needs that are beyond the capabilities of what the department is licensed to provide. So definitely, the we definitely have that challenge.

We also have in recent years implemented the health care provider networks. So not only for hospital hospitalizations, but we also do specialty medical care. We have to contract out for specialty services. So that is also included in those outside medical costs.

So we are working with, we contracted with a provider network to help us locate more or to try to help us identify more providers that can provide services that might help increase competition for rates because it is difficult with our population to find providers that will serve our population and often they want a higher rate in order to agree to serve our population.

You know, and I saw... Well, thank you for that. You know, outside utilization is the one that's dramatically increasing over against everything else. Is there any preventative measures we can, we can implement or turn to? Or is this just a matter outside of looking for more competition and so forth that I don't see, I don't know how we get ahead of that. It's just gonna keep growing.

It's very difficult with this population. They've had long term mental illness. They've had long term often institutionalization and time in incarceration and have, which ages a population earlier than the normal population in the community. We often see the advanced illnesses earlier than you wouldn't necessarily see them in the in the general population. So it definitely is difficult with this population.

We certainly provide, you know, we have an entire team of internal, of physicians that work on our, that are on our teams that are allocated out to the patients that provide all the preventative maintenance services. But they are generally have poor mental, poor health care outcomes due to the long term mental illnesses.

And so is it actual treatments that State Hospitals can't provide? Or is it a type of license that is needed? A type of certain healthcare worker that is not in the...

Yeah. So, so we are an acute psychiatric hospital. And so the model that we we operate under is that we are an acute psychiatric hospital. People are inpatient to receive acute psychiatric services. While they're with us, we also provide dental care, that will be a forthcoming item.

We also provide medical care, but that's more like outpatient services. And then we provide specialty care. Just like you and I may go see our physician in the community, we have physicians that provide our general medical care. And then we may have to see a special specialty provider for a certain ailment. We also either have the specialty providers or will contract out for them.

Now, when somebody gets to the point where they need a surgery or they have, you know, they have very significant medical needs that they need acute hospitalization for, that is beyond the level of services that we can provide. We just our our systems aren't designed.

Our buildings aren't designed for that type of care. We don't have, like, medical gases and those kind of things. Anesthesiology, all of those things that you would need in order. Surgical rooms, we just don't have all of that in our in our hospitals.

And I recognize we can't bill to Medi-Cal, but Medicare is eligible to cover these services and these are aging population who are eligible for that. What is the percentage of our population that is getting this covered by Medicare?

Thank you. We have about 18% of our population that is covered by Medicare. The challenge though is that patients have the ability to decline. They have to be willing to sign up for Medicare, and we definitely provide that education, but we also have the the challenge of a population that particularly within our long term population don't necessarily always see the benefit or the understand the benefits due to their mental illness.

Okay. And then talking about the IST solutions. You broke down all the savings since fiscal year 23-24. Can you share, maybe Department of Finance, this is a question for you, how much we're proposing in the January, budget to give in this category? And I should name the actual program. Yeah. How much are we proposing for IST resources?

Nothing new. We're just reporting savings.

Okay. So nothing is being added?

Right. Nothing is requested. We are just reporting savings of 117 million in current year. $94.2 million in the budget year. And then we had a 114 million from...

How much is left over? I guess maybe I should ask that. Is there any dollars left over in this fund?

Yeah. It's approximately just over $500 million total for IS, across our various IST solutions programs.

Sorry. Sorry. Let me let me see if I understand. I know we've, we're seeing savings from the past three years. Is that what you're referring to? This is gonna be about $500 million when you add them all up? Is that what you're saying, Chief Deputy?

Oh, I was, referring to the available level of budget for this fiscal year. It does increase in the out years. We're only reporting one time savings in the current year in the budget year.

Okay. Okay. Thank you. And do we anticipate that being utilized at its full capacity this upcoming year, given the ongoing lack of usage?

Yes. Yes. Yes. So we've, our savings are based on a review of the actual usage of the of the contract. Some of the most of this is related to the community based restoration and the diversion programs that have since moved from our pilot phase to now our permanent programs. And there's just been a slower ramp up for our counties to get to that maximum capacity of individuals served in the in the contracts.

So the solutions the department and Department of Finance are proposing is at the max that we can that we anticipate not utilizing?

Yes. Correct.

Based on what we know today.

And outside of the saving solutions proposed now, is there anything we're adjusting for better budget allocation under these programs?

So we don't continue over budgeting? We It seems like we continue over budgeting for this?

It's not necessarily that it's over budgeted.

It's just that it's utilized.

Well, we're in a period of of activation. So when we first, when we first requested the funding for our IST solutions, it was based on an assumed rate of activation of beds and capacity across our community diversion. That was, you know, back in 2022. And, and we were, creating a whole series of new programs and with the best guess of assumption of when a county might be able to come on and ramp up.

So we've the dollar amounts that we have are what we need in order to, serve if the each county that we're contracted with and each, community provider that we've, serve their maximum censuses.

But we have been in a consistent state of activation, and we're still in that consistent activation state. I think next year, we're finally gonna be, for the most part, with our community based restoration and diversion to the point where all the counties have activated their programs. And we'll start to see them, you know, in their their ramping up their censuses. So we'll start to see a higher level of expenditure in these programs over time.

But because we've been in that constant state there at the beginning when we requested the funds, we assumed that they they would come on in a certain period of time and and some of those things due to, you know, things outside the department's control may take longer for the county to ramp up their services.

Because of the longer period to ramp up outside of our control, is that impacting any kind of service delivery? Is there a gap that has been created because of that? Or, or, or are people like on a waiting list waiting for these projects too?

Yeah. I wouldn't say, I mean, at at what our system looks like today is that most folks are going still through our competency restoration programs in an inpatient setting. So versus having, a broader number of, community based beds for diversion and community based restoration. So it really is more about there's a higher proportion of individuals going into the inpatient settings still.

And, and, and our longer term goal as you know, part of IST solutions really is to try to mitigate the risk of IST individuals coming back into the system.

And that really is, grounded in the, the, philosophy around supporting diversion. And so that is what we're really now working towards. Okay. So it's not a full gap. It's it it it over time we'll, we'll start moving more towards more individuals being served in the community.

Okay. And then, chief deputy director. On the, the delay of activation on the new Central California facility, it's supposed to it was supposed to come online January 2027. The delay pushed it to what?

That that is our current activity.

That is the current. Yes.

Okay. Yes. We were assuming that it was going to to really be, coming online much sooner than that. Okay. So our current activation timeline is January 27.

And because the savings came from that, is there any need for any outside funding already ready to go for that activation?

That funding is ready to go.

Okay. Great. Thank you.

Okay. No further questions on the overview. We're gonna move on to issue number two. Gonna hold the item open.

Good morning, Napa Chair. Good morning. My microphone on? Okay. There we go.

Mark Beckley, chief deputy director for operations for the Department of State Hospitals. I'll be talking about the patent in Napa electrical infrastructure projects. For Napa, we propose 7,270,000 in general fund for the working drawings phase of the electrical infrastructure project. This project will upgrade the electrical distribution infrastructure from 2.4 kilovolts to 12 kilovolts distribution system. And includes the replacement of existing PG and E transformers, substation utility feeder lines, facility transformers, switch gears, and installation of new generators.

For the patent project, we proposed 1,760,000 in general fund for the preliminary phase, four plans to provide upgrades to DSH patents electrical infrastructure. This project has two, phases. The first phase is to upgrade the medium and high voltage elements within the electrical distribution system. And the second phase is to upgrade low voltage, electrical distribution at each of the buildings, replacing old panels and wiring.

The electrical infrastructure for both of these hospitals were installed in the nineteen seventies, and these systems are reaching the end of their useful life.

These projects are necessary to ensure resilient and reliable primary and backup electrical flow to our facilities to support critical HVAC lighting, alarm systems, and medical equipment that protect the health and safety of our hospital team members as well as our patients. In the agenda, there's a question about why fund the project now. These projects really are critical to ensuring that these hospitals can continue to operate and to predict the health and safety of our team members and our patients.

It takes approximately seven years to complete projects of this magnitude. And what we really want to avoid is any sort of like down times and electrical distribution.

Any, you know, resulting adverse impacts to our team members and or patients. The second question in the agenda asks about DSH's long term infrastructure plan for its facilities. And I'd like to start by describing the process about how we determine our infrastructure priorities.

So the DSH Sacramento facility team and their architectural engineering consultants regularly meet with hospital team members including executive management, plant operations, hospital administrators, clinical and safety team members to identify the infrastructure needs that pose significant threat to the operations of health and safety of hospital team members and patients. From this information, the, DSH Sacramento facility staff and their consultants then use a risk based data driven methodology to prioritize projects that have the greatest potential impact to the severity, to staff and patient health and safety.

Some of the criteria that we usually look at make these determinations and these are in rank order are the life safety and security, risk for patients and staff, frequency and severity of system failures, age and functionality of our buildings and infrastructure, impact on patient care and hospital operations, regulatory or compliance deadlines, and opportunity to bundle different projects for efficiency.

After we create this prioritized list, the DSH Sacramento facility team members then meet with DSH Sacramento executive and hospital executive team members to prioritize the list of projects. So I will describe what the core category of projects and examples of some of the projects in these categories are. The first category I'd say is to extend the useful life of our facilities. So I had mentioned the electrical systems upgrade projects.

In addition, we also have roof replacement projects, for 12 patient buildings across all of our hospitals. Two of those roof replacement projects have been completed and 10 are currently underway. Associated with the roof replacement projects, we also have the upgrade and replacement of our existing HVAC systems. The second category is our safety projects. So currently, we have fire safety and anti ligature projects underway at our hospitals.

We have fire alarm upgrades underway at our DSH metro and patent facilities. And fire sprinkler and water line improvements at metro in Kalinga. With future fire safety projects planned for Napa and Atascadero. We also have anti ligature projects underway at four of our older hospitals, Napa, Atascadero, Metro, and Patton. And then finally, I'll mention our DGS sponsored sustainability and energy efficiency projects.

We have solar projects, LED lighting, EV charging station projects across all of our hospitals. And I'll also note that the HVAC units that we're installing as part of a roof replacement projects are also replaced with highly energy efficient systems. And I am ready to take any questions that you have.

Before I find anything to add? Well, anything there? Oh. Yeah. No.

Okay. Great. Thank you. So these are being proposed as one time funding but they're part of an ongoing funding proposal. So Department of Finance, are the ongoing charges or ongoing costs being calculated in in the structural deficit?

Good morning. Matt Schuler, Department of Finance. Do you mean like the operation and maintenance? Or you're talking about like ongoing costs for

the next So there's this is like this is for at least for the NAPA one, this is part two of the request. Last year was a one time, but then again, coming back for a request and it's gonna lead up to, I think, $95,100,000 total. So they're ongoing budget request. I'm wondering if the rest of the funding is being calculated under the structural deficit.

Well, what I would say is I would point you to the five year plan or the COBCP where we would note, for example, each phase is one time and we typically, depending on schedule, if we're able to schedule it sequentially each year, those funds for that phase is a one time request.

But the project as a whole is ongoing the request for funding is ongoing. Like, I don't know how long it would the request are gonna, like, I think, until to lead up all the way to ninety five point one million dollars, we're gonna have to calculate into our structured deficit for at least, what, four, five years. Is that correct?

Correct. Yeah. We would build it into our multi year. So for example, 2627 for Napa as an example, electrical infrastructure upgrade. We've got 7,200,000 forking drawings.

We've logged 84,900,000 for construction and 2728. And that that would essentially end

the one Yeah. That 85. So is it being added? Is it included in our structure deficit?

Well, in our in our multi year view, correct? Yes. We do calculate we do calculate as as lump sums per department. Yes. For these for these projects that were proposed Okay.

To look at as as the years come.

I'm wondering though because once you start a project, I think it would be silly of us to stop the project in the middle of it. You'd have to continue. So I'm wondering why Department of Finance proposes these type of BCPs in a different manner. For other BCPs are x amount this year, x amount the next year until the project is complete.

And this is being proposed as a one time, which I don't view it as a one time, because you have to come back to continue the project.

I believe it characterizes as one time to say in the finance letter as an example to let you know that this particular budget year that it's just the one phase that's being requested. But the the methodology actually provides some flexibility. If we if come to a more deteriorated state next year fiscally and we have a phase, yeah, it would be

Worse than 18 to $20,000,000,000 deficit? Yeah.

It would be unfortunate to halt the project but, you know, for me perhaps a a 5% cost increase delaying it a year or two, the legislature would have the the flexibility to do that. Okay.

Well, I don't I I don't anticipate that administration never come in and say let's delay what we've already invested in. So I'm but but okay. So we're already in with the Napa. With the patent, if we approve this, we would have to be all in to approve the 61.7 estimated cost and then that would increase to x, y and Z. Mister Beckley?

Beckley, yes.

I'm

so sorry. I forgot your title so I apologize. I'm not I'm not using it. Whatever you're allowed to do without sugar coating like is patent gonna fall apart if we don't start this now?

Yeah. I mean, I I would say the again, it it kind of is that balance of risk. Right? So again you're looking at an electrical system that was installed in the nineteen seventies. It's been stable up until this point.

You know I'm not electrician or an electrical engineer to say you know when you'd see outages. But that is a real critical, you know, question and issue. Again, given the time frame it takes to implement these projects which can take as long as seven years. If you do lose a transformer, sure you could do piece mail replacements. But again, a transformer is a very large specialized piece of equipment.

And so it would take a while to actually install it. And there may be emergency workarounds that we could do. But you know it it you know I guess our concern here is it's it's very outdated infrastructure and we do get concerned about the risk of failure.

When I got briefed for state hospitals, the first thing I asked, I was like, Nori, tell me how many BCPs we have on on sewer, electrical or what they need to upgrade because I knew one was coming. I knew it. I'm surprised it's only one request but you grouped two into one so I guess it's two. On the Napa one, did we already complete the preliminary plans phase of the project?

I have our chief operating officer, Robert Horsley, can respond to that question.

Hi. Oh, hello. Thank you. We actually are waiting for DGS to hire their architect of record. And so, we are about 10% into the preliminary plan phase right now.

But the request is already coming for the second part, but that first one hasn't even it's nowhere near even 50%. So there's a potential of this request not even needing to kick in until the next fiscal year?

Well, the time well, sorry.

Or or is it done simultaneously?

Well, no. It's it's there's each phase. Preliminary plan phase, working drawing phase. We have to get approval through the Department of Finance and the State Public Works Board each each fiscal year once we finish that phase. But for the preliminary plan phase, that, takes a while for the DGS sometimes to actually get the contractor on board and hired.

The funding was sent to them on September. And the fund funding came to us in July. So, it's just the time period it takes to go through the contracting process sometimes. And we're waiting for that part to start. I don't see us delaying another year for the fiscal year to start working drawings phase.

The first phase is usually involving the CEQA and going through a lot of those early on preliminary design. So working drawings is when it gets a little more deeper into the drawings and actual project itself.

How long does the preliminary plan phase start once you actually get this contract out? How long does it take, sorry, for that part?

Typically, twelve months.

So you're not gonna be able to utilize the what you're requesting, $7,300,000 in this next fiscal year? Yeah. You won't?

Well, it it could it could some potential.

Twelve months and the contract hasn't been allocated yet.

Well, it's typical twelve months is a good rule of thumb, but we asked EGS about this. And at Department of Finance, we do question that because we will delay phases and not appropriate. If the schedule shows that it's not ready, and this particular one was showing, it should be ready by April 27.

Correct.

If a contract were to be put out this month but no contract has been made.

DGS has A and E retainer contracts and so they have A and A AORs on contract. It it's a work order process that they go through. It's not a typical solicitation award bid and award that you would see on a normal contract.

Okay. But the $7,300,000 would kick in in potentially April, three months before the fiscal year is over. You would have to do a contract. You won't even kick it because it doesn't sound like you would use the $7,300,000 in the next fiscal year. That's what it sounds like.

Well, according to DGS, there should they're basically estimating that would take less than twelve months. Twelve months, again, is just a rule of thumb for preliminary plans. But even if we ate into the next fiscal year a few months We'd still be saving that $7.08, 9 months on the back end of having to wait an entire another year with nothing to do At DGS as far as doing actual construction documents.

Okay.

And of course, with preliminary plans, we'll be, you know, help us focus in on the cost as well.

Okay. Vonda, did I turn to you? I I can't remember. Anything out here? You're good?

Okay. Alright. Thank you. We're gonna hold the item open. Thank you.

We'll move on to

issue number three.

Hello again. Welcome back. Hi. Chief Deputy Director, Program Services, Chris Edens. And I'm joined by Stacy Camacho, deputy director of our community forensic partnerships division which oversees our conditional release program.

This is a, budget change proposal about, SENATE BILL 380. The department is proposing 469,001 time in the budget year to support two one year limited term positions to implement, SENATE BILL 380. This bill requires the department to conduct a feasibility analysis on the establishment of transitional housing facilities for the ConRep SBP program and to submit a report to the legislature on its findings of the analysis by 01/01/2027.

The resources requested are needed to complete extensive research and analysis of transitional housing models and laws that are in other states, as well as, extensive research on the current law here in California. Resources also include operating expenditure funding to support travel to visit a few of these programs out, out of state.

And to consult with subject matter experts. The analysis will look at potential program designs, estimated costs, and identify statutory barriers to establishing this type of facility in California. That concludes my presentation. Open to any questions.

Yeah. A couple questions under this program. Where are we currently housing people and how many people do we have on the Conrep SBP programs? Sure.

Yeah. Yeah. Currently I think we're at a census of about 17 to 18. We fluctuate anywhere from 17 to about 22, 23 individuals on the community. As you imagine, it's very difficult to, find placement.

Placement is is, by statute, is required, for individuals to be placed in their, county of domicile, which is determined by the courts. Usually, placement looks like an in individual residence, within the county of domicile. So a single family home.

And how long can they stay on this program?

Until the court deems that they are, no longer, either no longer meet the criteria for SBP and maybe unconditionally, discharged, or, they may be rehospitalized, during their time in con rep if there is a violation of their terms and conditions of participation in the program. Off the top of my head, I don't know the length of stay. So I'll look to to deputy director, but it usually is a few years in the program.

It's not it's not indefinitely?

No. It's not indefinitely. It's not indefinitely. No. No individuals have to continue to meet the legal, criteria for continued commitment as a sexually violent predator.

Okay. And then how much does it cost us if it's like 17 to 18 people, single family homes, they're all living separate. Right? Single family homes across California? What's the annual cost?

Do parent finance, do you have those numbers or does someone have those numbers?

We can follow-up with that. Last time we had taken a look at our, annual cost per patient, it was running around 350,000 to 400,000 per year.

And that's only on the housing cost?

No. That that is for all inclusive services, housing, supervision. So annual cost per person about 300 to 400,000 per year.

Do you anticipate the report, coming out of SB 380? Are there other avenues that are more cost efficient to provide you housing?

That's what the analysis will, touch on. We did do an initial, sort of internal consideration of this. This is, this issue was initially flagged in October 2024, by the California State Auditor. There was an audit report that was released on the current rep SBP program and it did recommend at that point that the department explore the feasibility of establishing state owned transitional housing. We actually formally disagreed with that recommendation.

And and the biggest, for a number of different reasons. But really the the biggest issue is that we did not see that transitional housing would ultimately solve the problem of placing individuals in their county of domicile. Because ultimately, even if we do have a transitional facility, at some point, the court is going to then require and the individual is then ready to step down back into their community.

And so we will still be faced with the task of having to place individuals in in their county of domicile. Oh, interesting.

So is it gonna cost us more then? Essentially, yes. Oh. Oh, okay. Interesting.

Okay. Anything to add? Director Cissei Javier, I wanted to ask you another question on the ISE that we were talking about before. Yeah, sorry. I, I know I think I think either one of you mentioned that, you know, the goal is to go back into the communities and that's the ultimate goal.

But does that mean like will counties have the support, the funding available to house these individuals if the whole goal is to divert away from ISC into the community?

So on SB 1323, when they they are diverted Uh-huh. Through SB 23 in the interest of justice Yeah. They are ultimately diverted. The bill also included a change to, forty three sixty one, which is our statute for DSH diversion and allows the DSH diversion program to continue to pay for that.

So whether they got diverted whether they get diverted in the interest of justice or they get in, diverted after the finding of IST and referral to DSH, both pathways they will receive funding under the DSH diversion program for that.

So the IC solution to sound like they can be used in other areas to support that same kind of population?

It would be just for individuals found incompetent to stand trial on felony charges.

As we divert more people away from IST, I guess maybe we'll go back to the same question. Because you said, yes. It allows for that ability to fund and pay for that covered with the same funding. But then you said it's only used for IST, the funding.

Right. Because they're So the An individual under SB 1323 is first found incompetent to stand trial. And then the court makes the decision whether it is in the interest of justice or not. They're actually going to Yeah. So, if it's not in the interest of justice, they're still incompetent to stand trial.

Uh-huh. That finding hasn't been removed. So they're incompetent to stand trial, but the court is looking has options for community based treatment. If they land in a diversion program, that diversion program will be funded by the DSH DSH diversion program.

Okay. So funding can be diverted there. So the IC solutions of how much we're we're saving in the past three years, That is not being taken away from that kind of Okay. No. Okay.

Alright. Thank you. No. We're gonna hold item three open. Move on to issue number four.

Okay. For this item, I'm joined by Brandon Price who is our chief of hospital services. And the department requests three point nine million and four permanent positions in fiscal year twenty six, twenty seven, and 1,100,000 in fiscal year twenty seven, twenty eight and ongoing to support dental services provided to patients at DSH Metropolitan and Patton. This proposal includes spending for one trailer to serve as an expanded dental clinic at DSH Patton as the existing dental clinic cannot accommodate the additional resources.

The four positions requested include three dental hygienists and one dentist to provide adequate staffing levels to meet patient dental care needs and align resources at DSH Metropolitan and DSH Patton with that of other state hospitals.

Patients residing in the state hospitals often exhibit complex medical, psychiatric, and cognitive conditions that place them at elevated risk for poor oral health outcomes. The increased hygienist will focus on preventative care, allow dentist to prioritize urgent restorative care and exams. Happy to take any questions.

Okay. No questions here. Hold on. I'm open. And thank you for joining us today.

Thank you. Great. Moving on to our next commission for behavioral health.

Good morning. Brenda Grealish, Executive Officer for the Commission for Behavioral Health. Thank you so much for the opportunity, Chairman Menjivar, to provide a brief overview of the Behavioral Health Services Oversight and Accountability Commission, also referred to as the Commission for Behavioral Health. And our focus during the transition to the Behavioral Health Services Act from the Mental Health Services so we are an independent agency led by 27 commissioners.

And by statute, our membership reflects the breadth of pub of the Public Behavioral Health System, including consumers, providers, family members, community members, and state partners.

That structure isn't intentional, as we're designed to surface challenges from multiple, angles and develop solutions with a consistent focus on accountability and outcomes for Californians most affected by the public system. Our primary tools are data and policy research, program evaluation, grant making and technical assistance, and public transparency. We publish policy reports that combine data analysis with stakeholder input to identify what's working, what's not working, and what practices can improve statewide outcomes.

We also evaluate programs so that Californians can learn from implementation, improve performance over time, and clearly understand the results from public investments. A key part of our transparency work are public facing data tools including our commission on transparency suite which makes behavioral health data accessible to the public and decision makers.

On the grant making side, we fund and support local programs and partnerships across the age and care continuum, often pairing grants with technical assistance and expectations for collaboration, helping to reduce silos between counties, providers, and community partners. We also maintain a consistent emphasis on historically underserved communities through our community empowerment and advocacy contracts, which are designed to strengthen participation and ensure local planning reflects community needs. Under the Behavioral Health Services Act, the Commission's role is evolving in several important ways.

First, we continue responsibilities that remain active during transition. So County Innovation Funds can still be encumbered through June 2026, and so we're actively working with our counties to encourage timely, strategic use of those funds and to approve plans.

Second, the commission's pivoting to implementing innovation on the state level through our New Innovation Partnership Fund Grant Program, which provides up to 20,000,000 annually for five years to support innovative efforts that advance statewide transformation, which I'll talk about in our next agenda item. The third, we continue major initiatives such as the Mental Health Wellness Act, Behavioral Health Student Services Act, our full service partners evaluation and advocacy contracts, focused on nine specific underserved populations.

The BHSA also expanded the commission from 14 to 27 members last January, adding seats that have strengthened lived experience and system expertise across multiple sectors, which focus on mental health and substance use disorders. And right now, we're currently undergoing, look into our strategic plan to do an update to our strategic plan to focus on the BHSA transition. And, through that update, we're still on the process of it right now, but we're looking to focus on four priority areas.

One, including, strengthening accountability and results for people with the highest behavioral health needs. Second is, ensuring substance use disorder integration across the commission's work. Third is expanding peer services and peer led models. And the fourth is building the evidence base for innovations that can be scaled statewide. And I just wanna make sure I underscore what a significant moment this is.

The behavioral health transition is an extremely large and impactful system shift, that California has undertaken in behavioral health in in decades. Implementation at this scale is complex and it creates new expectations, new planning requirements, new accountability structures, and real operational impacts that the county and provider levels. So the commission's role at this moment is to really help California make this transition real and workable. To gather what is happening on the ground across our counties and our communities.

To bring transparency to how funds, programs, and outcomes are aligning with the intent of the law.

To surface what's working and where barriers are emerging and to translate those lessons into practical improvements through data evaluation, technical assistance, innovation and recommending strategies to improve implementation of the Behavioral Health Services Act over time. Any questions on our overview?

No. Questions on the next one.

Okay. Perfect.

You can jump on in.

Alright. I'll jump on into the next one. So with our Innovation Partnership Fund, I think

Issue six, everyone.

Oh, okay. Sorry.

Thank you. So there's a great background on the agenda on our Innovation Partnership Fund Work. Under the Behavioral Health Services Act, innovation moves from the county level to a statewide strategy. It's, this change is allowing California to identify what works, to build a stronger evidence base and move effective models beyond single county pilots so that promising practices can be tested with rigor, could be evaluated consistently and scaled across regions.

And it also creates a vehicle to advance statewide priorities while leveraging local expertise and community defined solutions.

So throughout 2025, the commission held extensive listening sessions with the community, which included providers, counties, state partners, variety of stakeholders to inform the development of a framework, an innovation partnership framework that morphed into a request for application for the first $20,000,000 allocation of the Innovation Partnership Fund. The RFA was released on March 20. The fund offers two distinct distinct grant categories. One for small grants exclusively for community based organizations, non profit entities, and tribal organizations.

So we're looking to have at least eight grants, under $500,000.

And then one for large grants that's open to all, including public, private, and non profit entities. And we're looking for at least three in that category, for between $500,000 and $5,000,000. The interest has been substantial. So since we released the RFA in March, we've received over 400 questions, and have held two bidders conferences with over a thousand participants. So given that level of engagement, we are anticipating a quite robust pool of applications which are gonna be due on May 8.

So the timeline, to announce the awards we're anticipating would be in mid June and, we would be looking to start those contracts in alignment with the BHSA Local BHSA implementation on July 1.

And then right on the hills of that, we will begin planning the next round of Innovation Partnership Fund work. Did you want me to stop there or continue to the next question? Okay.

Go ahead.

The next question. Okay. So, another one. In terms of the types of awards the commission's considering as innovative, those include, innovation services solutions that could be pertaining to services, technology, training, tools, or any other modality or format that improves behavioral health services act programs and practices with a focus on the BHSA priority populations.

And so just as a reminder for those, that might not be tracking those BHSA priority populations that are defined in statute, which are those who are at risk of homelessness, institutionalization, conservatorship, involvement with the justice system, and or involvement in the child welfare system. And so to be eligible for the this grant program, proposed solutions must be innovative. We have the definition of innovation.

It needs to address the needs of these BHSA priority populations and then needs to apply to or support, county implementation of programs or practices to best serve the BHSA priority populations. And so for the purposes of this first round RFA, the commission we're defining innovation as a newer adapted or expanded approach to solving persistent problems in California's public behavioral health system, especially those that relate to equity, access, workforce expansions, any service fragmentation, and anything that can enhance the quality of services.

And so, to be considered innovation, a project has to advance to newer culturally competent models, tools, partnerships, or technology that's not widely implemented in California. It needs to introduce or scale practical community center solutions that increase access to behavioral health services. It needs to be or demonstrate a clear break from the status quo. It needs to be actionable and ready for real world implementation.

And it may include ideas from other sectors or geographies adapting, adapt adaptation to promising practices in new areas or bold new models co created with people with lived experience.

So at its core, innovation is about transforming how care is delivered with impact, with equity, and with dignity. Finding the time and capacity to design, test, and evaluate new approaches is genuinely difficult. By moving innovation to the state level under the BHSA, the commission has an opportunity to take on more of that forward thinking function, creating the space needed to do the piloting, measuring, and scaling of solutions that counties can adopt without having to build everything from scratch.

So thus far, the response that we've received on the RFAs is encouraging, since given the high level of interest. So we're hopeful, and we intend to translate that interest into some actionable projects with measurable outcomes to support counties and improve results statewide.

And moving to the last question on the Innovation Partnership Fund and how we'll ensure that these resources are able to have the same level of impact as they had at the county innovation level effort. I said just to make sure that everybody is aware that counties can still, fund innovative pilots under the Behavioral Health Services Act through the Behavioral Health Services and Supports Component. And that makes up about 35% of county funds.

But unlike under MHSA innovation, the BHSA no longer requires the commission to approve those projects. And so innovation is now one new option within that bucket alongside, other allowable uses for counties that also includes things like early intervention.

So that counties can retain their flexibility to innovate locally, while the Innovation Partnership Fund at the state level creates that statewide dedicated statewide pipeline to test, evaluate, and scale approaches that counties can later adopt. At the same time, the Innovation Partnership Fund is smaller than the private prior MHSA innovation structure. So our approach is to maximize impact through our projects, by and really looking to impact how changing how innovation happens.

So really, by taking the burden off the county since under the old model or the previous model, each county had to design, and administer innovation while also running its core system, the commission has, the opportunity to do that in a dedicated space. Secondly, it creates a statewide pipeline for innovation.

So just not just for counties or from counties. So we're seeing inquiries from a variety of organizations, including community based organizations, tribal partners, universities in the private sector. And that matters because some of the most scalable ideas, are happening outside of government or are being researched at our universities. At the same time, we're being clear that their proposals must benefit, County Behavioral Health programs and again, support their implementation, their their ability to best support and serve the BHSA priority populations.

Third, we're designing for scale and adoption.

So really looking to have that system wide impact and improvement impact. So not just doing one off pilots. And the goal is to generate innovations that can go beyond a single project, produce measurable outcomes and reduce fragmentation so counties can adopt what works without having to start from scratch. So even without few the dedicated dollars, the IPF has the potential to derive these really big statewide impacts. And really build capacity in our state.

So there.

Anything to add? Either of you? Okay. Quiet over there today.

Thank you so much for really robust in-depth background on that. Painted a really a good picture that I could understand. On the small and large grants that are available and I'm excited to see what comes out of the announcements on June 15. How long do we anticipate this funding to last?

Well-

Or do we give them a timeline or do they get

It'll probably be three year contracts that we would be doing with them, so they wouldn't be just one year of funding to hurry up and do a project. They'd have time. So we would take the the funding allocated to them, enter into the contracts and then and then monitor those over time to make sure we're progressing on the projects.

After the three year, are they allowed to apply again for extended funding?

You know, we haven't operationalized all that yet. So I think this is all in development. And so, this is our first time, working on this. I think there's nothing that precludes this. At first blush, I'm not aware of anything that

Okay.

Precludes that. It's an interesting question. And so, as soon as we're done with this round of grants, we're gonna start our next planning for our next round as well.

Because this is $20,000,000 forever, however long this continues. Right?

It's this IPF is $20,000,000 and up to $20,000,000 for five years.

Oh, it's only for five years?

Only for five years. Yeah.

So essentially, you can only get a request for like two more years.

Well, it's for it's $20,000,000 per year and we get that allocation every for the next five years. And then post what? 2031, I think is that what that takes us out to? Then we'll have to start asking for more through budget requests.

Because no more would be allocated under the prop one bond.

Yeah. It's a $100,000,000.

Got it. Okay. And can can they apply for both a small and large or one or the other?

Yeah. That's actually a great question. I think I can remember seeing it in the RFA. There is there are some limitations but I think if what they do apply for more than one grant, they have to go for separate. They have to separately apply for them.

I'm actually saying, can this? I don't know. They can?

Okay. Sorry. I was looking at my team. They said that they can.

And then, so you mentioned you gave a descriptor of what is being considered innovative. It's not like something they've been doing and they just wanna expand that. Right? It's all bright new.

You'll be expanding to new new populations. So say you tried something in one county and now you wanna try it in another county, that could be considered innovative.

I don't know if you have the answer to this right now. But later on in this year, we're gonna be hearing about mobile unit. Mobile crisis units. Yes.

It was a pilot program investment. I don't think it's pilot pro It was investment. The funding expires. Even though we've done that for a couple years for expanding it, would this qualify as an eligible innovative to expand it to other areas? Or is that to

Well, if it's something that's gonna be new. You'd have to meet that definition of innovation. So whatever would be done would have to meet this within these parameters of that definition of innovation.

You gave an example of training. So if they just wanna train their employees that covers it?

Like if there's a new training that there and so somebody's looking to train a workforce on some sort of new something or new program or practice. Then if it was an existing one, it wouldn't meet the definition of innovation. But if there was something new that was a new way of doing things, then that could potentially be.

That's a little worry because I'm like, I don't wanna see campaigns. I don't wanna see public campaign or you know, awareness being funded through this. I don't wanna see training. Like I wanna I hope as the commission approves this, they're like actual service deliveries, kind of innovative investments.

I will say too, part of the statute signified that the commission would work in collaboration with CDPH, HCAI and DHCS. So that has been part of our work through all of this. And so, we would definitely wanna stay very coordinated with that. And CDPH now has that population based prevention.

And, just to clarify. Post the five years, there's a potential for the commission to say, "hey, we've been funding this for the past five years. We no longer have bond money. We would like to general fund to keep funding them" Or that for If I need the grants for. Yeah.

I mean, even. Yeah.

Here we go, Will.

Oh, Willam with Legislative Analyst Office. I'd like to so the commission would probably have the opportunity to state has up to 3% funding from the BHSA of total revenues to use for behavioral health initiatives. So that's an area of money if the that wouldn't be general fund that the commission could go.

Can turn to.

Can turn to, you know, pursuant to the allocation by the legislature.

Okay. Thank you for that. Okay.

Thank you. We're gonna hold the item open.

Great. We'll go to issue number seven.

Okay. So issue number seven, the All Cove Youth Drop in Center's extension. So, this is a proposal to extend the liquidation deadline for our All Cove Youth Drop-in Centers Grant Program.

And this model was adapted from a successful international youth one stop shop model, that was initially developed in Australia and then moved to California, Canada and Ireland. And it is, they basically are stand alone youth friendly centers where youth, ages 12 to 25 can access support for mental health needs, physical health, substance use, peer support, supported education employment, and family support. All Cove in California initially began as a Santa Clara County Innovation Plan Project in partnership with Stanford, which helped create and refine the model.

Subsequently, the Budget Act of 2019 included $14,600,000 in one time grants over a four year period of time to support the establishment and expansion of All Cove models statewide under the commission. So in January 2020, the commission allocated $10,000,000 for site grants and $4,600,000, for Stanford to provide technical assistance and conduct an external evaluation.

So that investment has resulted in five All Cove sites, which are in Palo Alto, Beach Cities, and San Mateo. All three of those are open. As well as, San Juan Capistrano and, Sacramento, which are both open for some services but are working on their fidelity, to be able to have grand openings in the near future.

So just for clarification, this proposed extension that we're asking for, this reallocation is separate from what's been done with the Children Youth Behavioral Health Initiative rounds four and five grants, which went to some All Cove centers. So while the commission helped, had conducted the CYBHI round four and five grant procurements, all those grants are administered by the Department of Healthcare Services.

All those grants and all that funding has been allocated and disseminated to their sites. The commission, however, holds the still holds the technical assistance and evaluation contract with Stanford for all of the All Coves. And, really that work is to support the implementation of all of the All Coves and the evaluation efforts.

So for this particular, reappropriation for our commission funded All Coves sites, we're requesting an extension of the liquidation deadline for up to $4,062,000 of the remaining one time behavioral health services funds, to support the finalizing of these All Cove projects, the Commissions All Cove projects. There were some delays in site development and staffing and shifting and funding structures.

And, while all of our CBH funded centers are operating, like I mentioned, not all have met the full fidelity. There's a couple that are still working on that. So, really, we're looking to have that extension so that we can continue the funds so that they can just finish spending down the remaining funds. Otherwise, they revert on 06/30/2026.

So it's just in a couple months, before they would be able to finish their implementation, stabilize operations, and really wanted them to finish collecting that data so that we can have the data for all of the sites for the final evaluation.

So basically being able to get this final this re-appropriation will help protect our state investment, allow these programs to finish implementing as designed and making sure that Stanford can get all the, as the independent, TA entity and their evaluator to get enough data to evaluate and produce the final report for us next year, next spring.

Great. Okay. I have no questions for you either. Thank you so much. We're gonna hold on and we're open.

Okay.

Thank you for being with us today. We're gonna move on to our Fire Department, DHCS. I'll start with issue eight on an overview on the behavior programs overview.

Alright. Ready for me to jump in? Thank you. Paula Wilhelm. I'm the Deputy Director for Behavioral Health at DHCS, and my colleagues with me today are Marlise Perez, who is our Project Executive for Behavioral Health Transformation and also our Division Chief for Community Services. And then I also have Ivan Bartowage, who is our Division Chief for Medi-Cal Behavioral Health Policy. So, I will jump in first. The committee requested a brief overview of significant program changes related to our Medi-Cal Specialty Mental Health or Drug Medi-Cal, Drug Medi-Cal Organized Delivery System services for the '25-'26 and '26-'27 state fiscal years.

So, during this time period, the department has continued to focus on implementing the behavioral health components of California Advancing and Innovating in Medi Cal, or CalAIM, while also launching new benefits and activities under the behavioral health community-based organized networks of equitable care and treatment initiative, which I will now refer to as BH Connect.

As you may know, CalAIM benefits and policies for behavioral health included the launch of Medi Cal peer support specialist services, mobile crisis services, contingency management services, also known as recovery incentives, and more recently, traditional healthcare practices. CalAIM was also focused on updating our administrative policies in order to reduce complexity for our plans, our providers, and our Medi Cal members, and improve behavioral health access and quality. So, some of the policy updates we've made include updated criteria for access to specialty mental health services.

Our no wrong door policy for mental health. Standardizing screening and transition tools to help people access mental health services, updates to our clinical documentation requirements, and, behavioral health payment reform. So, we continue to sort of update those policies in response to feedback. And early this year, we finalized and published refinements to guidance on the specialty mental health access criteria. So, we now have a list of DH-approved youth trauma screening tools that can help practitioners determine when youth meet the criteria to access specialty mental health.

We also made updates to our standardized screening and transition of care tools for mental health services, and those were to allow practitioners to intervene or override the screening tool direction based on their clinical judgment. And all of that in response to, you know, watching implementation play out and getting feedback about, areas where different, different or further guidance was needed.

So, a new CalAIM priority that we'll be focused on in fiscal year '26-'27 will be the implementation of updated standards for Substance Use Treatment, or SUT, provided through our Drug Medi-Cal and Drug Medi-Cal Organized Delivery Systems. You'll hear me say DMCODS, for Drug Medi-Cal Organized Delivery System, repeatedly here.

Under existing law, Drug Medi Cal and the DMCODS providers must use American Society of Addiction Medicine, or ASAM, criteria to determine the appropriate level of care and treatment services for Medi Cal members. So, ASAM has now released new clinical standards referred to as their fourth edition standards that must be adopted both in medical, as well as by DHCS-licensed SUD treatment facilities, which we'll touch on in a later issue.

So, throughout the remainder of this year, DHCS will be engaging stakeholders to develop guidance to adopt these new standards throughout our SUD treatment systems to support continued use of evidence-based, high-quality care, and we anticipate publishing final guidance on this in early 2027 so that our systems can implement by July 1st of next year. I also—I wanna take a minute to highlight really promising data also in the SUD space regarding our DMCODS contingency management benefit.

So, this was, of course, started as a pilot program, which has now served more than 13,000 Medi Cal members, and we have more than 119 active sites in 21 DMCODS counties. So, have seen real growth in this and we're also excited about the data that shows the efficacy of this evidence-based intervention for stimulant use disorders. So, we have seen that 95% of our Medi Cal members who receive contingency management test negative for stimulant use over the course of their treatment.

And that 95% exceeds the average of 85% that we generally see in the literature on this service.

We'll also mention that those 21 counties that are providing contingency management cover approximately 80% of our Medi Cal members right now, so, we're really looking forward to continuing to build this capacity, for this important service. Over the course of 2025, we also worked closely with tribes and tribal partners to implement Medi Cal coverage of traditional healthcare practices. So, this was an exciting first in the nation approval that we received alongside three other states in 2024. And so, 2025 was our initial year of implementation.

Traditional health care practices are intended to improve access to culturally responsive care for our American Indian and Alaska Native Medi-Cal members who are seeking care for substance use. Traditional health care practices are exclusively offered through our Indian Health Care Providers, or IHCPs, for Medi-Cal members in all of our DMCODS counties. So, this is a requirement for DMCODS counties, if they have an IHCP that chooses to participate, to cover those services. We released our initial implementation guidance on this benefit in March 2025.

And at this point, we've approved 21 IHCPs Indian healthcare providers around the state to serve Medi Cal members with traditional healthcare practices.

We'll also mention that we were initially authorized to cover traditional health care practices for two years and change, so, just through the end of December 2026, but we do plan to seek renewal of this opportunity for up to five years in our forthcoming CalAIM Section 1115 waiver renewal application. So, really hoping we'll get the opportunity to continue building and expanding on this. Shifting to talk about BH Connect, which continues to be another area of focus for us.

You may know and remember that BH Connect is a group of policies designed to strengthen and increase access to a continuum of community-based behavioral health services for our Medi Cal members who have the most significant behavioral health needs. So, to date, we've implemented multiple components of the BH Connect initiative. In 2025, we were able to launch our $1.9 billion access reform and outcomes incentive program. So, this program creates an opportunity to reward our county behavioral health plans for improved performance on quality measures.

And we did make initial payments totaling 48.6 million to 42 counties based on their progress on these measures, and that's consistent with our planned schedule.

So, by the end of this year, they'll have an opportunity to earn quite a bit more for their performance during calendar year 2025. DHCS is also working really closely with the Department of Healthcare Access and Information, or HCAI, to launch the behavioral health workforce initiative. So, this is a $1,900,000,000 program to expand our behavioral health workforce in Medi Cal.

In 2026, we will—DHCS and HCAI will offer rounds of loan repayment and behavioral health fellowships, as well as scholarships, training for our community-based providers, and also, grants to behavioral health services providers at the organization level so that they can provide recruitment and retention incentives to their workforce. Notably, all award recipients, since these are Medi Cal dollars, must commit to providing services in a medical behavioral health set—setting—for a period of two to four years.

Also under BH Connect, we have been able to expand cut Medi Cal coverage for key evidence-based practices. We have a total of nine counties that have already taken up the opportunity to cover some of these evidence-based practices at county option. These include highly effective models like Assertive Community Treatment, or ACT, coordinated specialty care for first episode psychosis, and supported employment services. Many of these services are also required for counties to provide, as part of their Behavioral Health Services Act implementation, effective July 1st.

And so, BH Connect offers counties the opportunity to draw down federal funding for these interventions and use Medicaid dollars to help build out those BHSA required programs.

Counties that commit to implementing a full suite of new evidence-based practices also have an opportunity to receive federal financial participation for short term stays in inpatient or residential facilities that qualify as Institutions for Mental Disease, or IMDs. As of April 2026, we have four counties that have been approved to participate in this mental health IMD program and will be focused on building out those evidence-based services, and reinvesting the additional federal financial participation that they will receive.

And those counties are Riverside, Santa Clara, Sacramento, and San Diego. So, looking forward to supporting their efforts. Finally, as of 01/01/2026, our transitional rent services, which are offered through our Medi Cal managed care plans were implemented and became available specifically for the behavioral health population of focus.

So, individuals with significant behavioral health needs may qualify for transitional rent. Looking into this year between January and July, still sort of the final push on getting our BH Connect implementation guidance out. Specifically, we're looking forward to finalizing guidance to support implementation of several key initiatives focused on children and youth. Notably, we will issue updated standards for coverage of high fidelity wrap around for children and youth, and that will take effect July 1.

Alongside these updates to Medi Cal coverage, again, High Fidelity Wrap Around will be part of the BHSA implementation.

So, this is an evidence-based intervention to support youth with complex and significant behavioral health needs, and it will be used for youth who are accessing care through Behavioral Health Services Act, or BHSA, full-service partnerships. Finally, we anticipate launching our activity funds initiative by July as well. Activity funds is a really innovative opportunity to support strengths building and wellness activities for child welfare involved youth specifically, again, through the Medi Cal program.

So, the next couple of questions in the agenda were focused on Behavioral Health Services Act, or BHSA, implementation.

Before I move to those, were there any? Okay. We'll keep going. So, the committee had asked if the administration tracked or analyzed local county behavioral health programs that may be defunded due to the reallocation of funding included in the BHSA and also asked about how the department plans to address any loss of reach or capacity represented by the closure of local programs.

So, first, I think DHCS really wants to acknowledge the incredible engagement and thoughtful feedback, recommendations, and concerns we've received from our counties, our providers, a whole array of behavioral health stakeholders, community members, and from the legislature as we are working to faithfully implement the Behavioral Health Services Act Statute.

This was a vision for transformational change that requires fundamental updates to the way counties organize and finance public behavioral health services, and the way they prioritize populations, which Brenda alluded to earlier. So, as we all manage that change, we recognize there will be difficult local decisions about how to prioritize spending and many implementation challenges to navigate and respond to.

The BHSA did reimagine the required program components that were formally under the Mental Health Services Act to ensure the BHSA priority populations receive evidence and community-based services. So, you're familiar with the three BHSA categories of housing interventions, full-service partnership, and behavioral health services and supports. Counties are required to develop three-year plans that address these identified priorities.

DHCS is committed to then monitoring county performance and progress toward our statewide behavioral health goals as implementation proceeds after July. We have primarily heard from stakeholders about reductions in local, prevention-oriented contracts in response to the shift in responsibility for BHSA prevention activities to a statewide strategy that is managed through the Department of Public Health. We do not track or analyze specific contract changes or cuts that might be made at the local level.

Our focus is on ensuring that counties submit complete and compliant three year implementation plans, which they're just completed their draft plan submissions and are moving to final. And that they spend their behavioral health funds according to those plans. And then again, we will look to see them demonstrate improved outcomes consistent with the intent of the act.

So, we also wanna note that as we are doing change management and partnership with counties, providers, and the community, the BHSA is really intended to work in concert with a host of other behavioral health initiatives that have launched in recent years.

So, we have opportunities to bolster existing projects, add new benefits, and provide counties with additional funding, as well as support from other pay—payers. So, some of these complimentary initiatives you're familiar with include CALAIM, BH Connect, and our Children and Youth Behavioral Health Initiative.

I think sort of our final note on this point is to emphasize that Medi Cal members remain entitled to receive all of our covered specialty mental health and DMC—DMCODS—services, from our county delivery systems. So, these Medi Cal services must be preserved and prioritized by all counties as a federal requirement, even as they are navigating other changes through implementing the BHSA.

So, the last part of this, this issue was some questions about HR 1 implementation and specifically, the impacts of HR 1 on Medi Cal members with behavioral health needs, but those with milder or less complex behavioral health needs who are often served, not by the county delivery systems, but in our non-specialty mental health delivery system. So, would like to share that we will use a two-part approach to support people with mild to moderate behavioral health needs throughout the HR 1 transition.

We will work to keep Medi Cal eligible Californians enrolled in coverage while continuing to drive improvements in access and quality across our behavioral health delivery systems.

So, DHCS's HR 1 implementation plan is first focused on minimizing coverage loss to the greatest extent possible. While some loss of coverage will undoubtedly occur, we are proposing key strategies to mitigate the impacts on Medi Cal eligible Californians with behavioral health conditions. So, some of these strategies include working to inform our members of changes ahead of time and using clear, linguistically-accessible informing materials and member focused toolkits.

We're also working to simplify the Medi Cal eligibility and renewal experience and really maximize automation of eligibility determination and verity, excuse me, verification of work requirements. And then, finally, we are focused on carefully implementing the allowable exemptions to the HR 1 work requirements in compliance with federal guidance.

So, we'll highlight a couple of specific proposals that the administration has put forward that should support continued Medi-Cal coverage, including for folks with the less significant behavioral health or mental health needs. There is a proposed investment of 4,000,000 in total funds for clinic navigators to help guide Medi Cal members through the work requirements process at application and renewal.

And there is also funding proposed for an outreach cap—campaign—at 17,500,000 total funds, with half of that being general fund that would involve a marketing vendor to develop a tactical outreach strategy to raise awareness. We'd be developing social media toolkits for our providers, our managed care plans, tribal partners, coverage ambassadors, to, again, better, more effectively reach and inform our members. This would also include earned media, paid me—and paid media in all 19 of our medical threshold languages.

So, both of these proposals present opportunities to reach and support individuals with behavioral health conditions, including those who are likely to be served in our non specialty system, and those who may be less likely to qualify for work requirement exemptions. We are also developing a comprehensive strategy to implement exemptions to the new HR 1 work requirements with a key focus on exempting people with mental health and substance use disorder. So, wanted to take the opportunity to share a few points about this.

Wherever possible, DHCS plans to leverage available electronic data sources to automatically identify the individuals who meet work requirement exemption criteria. So, this process is referred to as ex parte and is the most powerful tool we have to maximize retention in Medi Cal and reduce administrative burden on our Medi Cal members so that they don't have to raise their hand, fill out paperwork, say I qualify for an exemption.

We can identify them and they will have that exemption in the system. We are conducting also extensive research to design one of the exemptions. People who are qualify as being medically frail are exempt from the work requirements.

So, we've been soliciting feedback on the proposed medical frailty criteria from chief medical offers—officers from our Medi Cal managed care plans, from the American Medical Association, and from external Clinicians, affiliated with medical societies and disease specific organizations representing a broad range of clinical specialties to make sure we have a sound definition of who is medical—medically frail—and should have these exemptions. So, while that particular exemption will be key to ensure individuals with SUD and significant mental health conditions are exempt from the work requirements, it is accurate that the mental health disorder must be considered disabling to qualify for an exemption under HR 1.

Thus, the focus of the committee's question on individuals with milder mental health needs makes sense and we are looking to these other strategies that I mentioned to support them. One last opportunity I'd like to call out that we really hope can help Medi Cal members with a range of needs stay enrolled through HR 1 implementation.

This is a new proposal that we hope to include in our forthcoming, Section 1115 waiver renewal request to our partners at the Centers for Medicare and Medicaid Services. We will seek CMS approval to include employment supports as a county option, but to be covered as a Medi Cal benefit to address barriers to employment, support sustained workforce participation, consistent with the work requirements, and promote economic stability more broadly among our Medi Cal members who are subject to these requirements.

And so, point of clarification, we have an option right now for county behavioral health plans to cover supported employment services, for the population they serve. But if approved, this new proposal that could be administered by, any county entity could help make employment supports more widely available to the broader population, not reliant on having significant behavioral health needs.

So in addition to these strategies, to keep members enrolled in Medi Cal, on the non specialty mental health side, we're also excited to use the new behavioral health performance measures that we've developed as part of BHSA implementation to really monitor the performance of our managed care plans as they, cover this population who needs non specialty mental health care. They will provide that coverage while also, of course, partnering with our county behavioral health plans to improve care coordination and outcomes.

So, some examples of measures that we are looking at under BHSA that will help us monitor progress with this population that uses non-specialty services.

We'll be monitoring receipt of core behavioral health services for that non-specialty population. We'll also be looking broadly at access to medications for addiction treatment, which are managed care plans and our fee for service system can offer. We'll be looking at coordination of follow-up visits after somebody has a behavioral health crisis, and also, consistent use of depression screenings to identify people who may immediately benefit from non-specialty health mental health services.

So, we are hoping that all of these interventions can be deployed to help prevent behavioral health conditions from becoming more severe, when Medi Cal members access this care. DHCS will certainly continue to communicate closely with the legislature and the broader public as we work through HR 1 implementation.

Want to note that we use our quarterly stakeholder advisory committee and our behavioral health stakeholder advisory committee meetings to discuss HR 1 implementation updates. These meetings are open to all members of the public. We'll also plan to continue offering HR 1 specific webinars and informing materials as well. So, to address the last question on the agenda, DHCS was asked to confirm whether we have generated an HR 1 impact estimate specific to individuals likely to be served by county behavioral health delivery systems, who may lose coverage.

We have not generated that specific or focused estimate that you're asking about.

So, we very much welcome the legislature's feedback and partnership on these efforts to keep Californians with behavioral health needs enrolled in Medi Cal, and the broader efforts that I've spoken about to continually improve access and quality within our behavioral health delivery systems. Thank you and happy to hear questions.

Have some water. There's a lot. Anything to add? Okay. You're okay.

Good. Can you clarify, when you were talking about the work requirements part, are you saying that the mild to moderate are gonna have the work requirements who are under managed care plans?

Yeah. So, the population that is subject to or most impacted by the work requirements are going to be adults ages 19 to 64, who, primarily those who are enrolled through the ACA expansion eligibility groups and then who do not qualify for any of the exemptions. And so, there are, named exemptions for people who are disabled, people who are actively in substance use treatment, and then, people who are medically frail. That's the one I expanded on a little bit.

But we do expect that there are a lot of adults in that ACA expansion population who may not meet that exemption criteria. And so, they are the ones who would hopefully benefit from things like additional employment supports, trying to simplify and automate perhaps the redetermination process, etcetera.

And then, when you get—when you were giving examples when you were talking about the programs that counties are now gonna have to reconsider if they're gonna be funded, since it's not funded from previous MHSA to be an HSA. You gave, you gave a couple of examples but two in particular stood out to me. CYBHI and COWIM. CYBHI, there's not a lot of funding left under CYBHI outside of the just like the, the hot—the hotlines though.

The support platforms, yeah, for youth and maybe fee for service. So, like, how really can CYBHI cover some of the programs that counties are gonna be closing? I didn't see the connection there.

Yeah. That question makes a lot of sense. I think what we were trying to call out is that these different behavioral health initiatives including CYBHI can help broadly support the population with behavioral health needs and also, bring in other payers and funding sources. So, under the CYBHI umbrella, for example, we think about, school behavioral health and the fee schedule that we've been using and expanding to ensure youth, but also folks in our colleges, can get access to behavioral health services there, in schools.

So, I think we were, when, when we made that comment, we were meaning to kind of point to there's a lot of different systems and funding sources that we are trying to improve to support people.

Because when I looked at, you know, if, if you looked at our, the committee's analysis on, on this, there's—they gave two examples of two different counties. It's a long list of programs that they're gonna be cutting. Are we—and I know there hasn't been an analysis, at least on the HR 1. But is there an analysis, I think you spoke, yeah, you did speak a little bit on this of just like, is there gonna be a service gap?

Yeah. I mean, I think we, you know, we made the same note that I saw in the agenda which is that, there is now an opportunity for a statewide prevention strategy, through Department of Public Health. And so, we hope that that will fill potentially part of the gap. And then, we will need to, I think, monitor and assess, particularly with this array of different initiatives and funding opportunities that we have in play to learn, right, what isn't funded or prioritized or where gaps may continue to exist.

Because the funding that public health is getting, I don't remember. I can't—if we spoke about this. But I don't remember any of that covering kind of this direct service delivery. So, still a little worried. I'm wondering, you know, how are we gonna continue to get feedback from counties like, hey, these are all done.

These are the services we're missing now. Like, how far in advance are we gonna be able to see that a gap is being created to be able to address and see what we can do in the meantime? Is there opportunity for that?

Yeah. I, I think we will need to listen to that feedback carefully and also look at the performance indicators I mentioned. I, you know, counties do have opportunity and a mandate to fund early intervention. Right?

So, I think the intent is that there is a prevention strategy. There is some opportunity for early intervention. There is a requirement that counties maximize their Medi Cal dollars, right, which should improve their revenue and allow them to reinvest in other types of programs. So, that...

That's hard when a lot of people are gonna be falling off of Medi Cal. So, it's hard, like, if we're depending on Medi Cal to cover a, a bit, but so many are gonna fall off of Medi Cal. It's, it's.

It doesn't really-- you can't turn to that as the saving grace, I suppose. But you mentioned three examples of what you, at least, or the department's doing to help. I think you mentioned, like, to inform ahead of time and to try to streamline and so forth, and hopefully we can keep people on as much as possible just so the counties can actually turn to those dollars for this. You wanted to add something?

I would just-- oops. Sorry. Helps to turn it on. I would just add that we are gonna be learning a lot through the Integrated Plan process because we have all these funding sources that Paula was mentioning that are at the county level. We have seen, you know, and are hearing from our providers it is a lot in the prevention space since BHSA funds cannot be used for population-based prevention.

But as Paula mentioned, you know, we've also heard counties looking-- you know, some of these providers also provide early intervention services. So maybe it's, you know, helping educate them on what can be provided under early intervention, which is really focused more on the individual, but then perhaps supplementing with, like, Opioid Settlement Funds which can be used for, like, population-based prevention such as campaigns, stigma reduction, opportunities like that.

So it is a shifting landscape. You know, as they're, you know, working out their plans and their funding sources, I think we are, as Paula said, gonna learn a lot too as our phase two measures come out this summer. So there is a lot in flux, but I think there's also-- like Paula mentioned, there are different-- we're doing so much in California, which I know we all know, but I think with having this Integrated Plan, we're gonna be able to see at a level of transparency that we've never had before as to where our county's putting their funds and also rolling out new data systems to be able to see how these individuals are impacted.

Okay. Thank you for that. We've done two rounds of the Bond B trip?

Yes.

Okay. I'd like to hear a little bit more of that of what mostly is getting funded. Is it-- are we actually creating beds or are there more expansions? New infrastructure? Can you just dive a little bit more into it?

Sure. I'll take that one. I'm happy to take that one. I can say, as of last March, we have granted out 5.8 billion dollars of all of the BHCIP funds. So that was the initial investment of 1.7 billion and then with the addition of the 4.4 billion of the bond. So in March, we did the bond round two.

But altogether, we have funded 437 infrastructure projects, which is creating an expansion of 546 either brand new behavioral health facilities or current facilities that are, like, expanding a wing or some type of access. That's creating over 9,553 new residential beds. So that's for mental health and/or substance use disorder. And then over 47,000--

What kind of residential? Those are--

Yeah. So those could be-- so, like, for mental health facilities, that could be like an MHRC. That could be a-- the new PRTFs.

I'm so sorry. These acronyms.

Oh, I'm so sorry. Oh shoot. I picked ones that I don't--

Mental health rehabilitation center or psychiatric residential treatment facility, which is a youth-focused setting.

Yeah. Or like SUD, substance use disorder resident--

That I know. That I know.

Okay, good. I know that one too. Because it's over 20 different facility types, but also, like, peer respites, so all across the care continuum, but those are the bed types. And then outpatient is more for, like, mental health outpatient type services. Like someone coming in for the day, we'll have day treatment type services.

Do you have the breakdown of this is-- what's available for tribal, counties, MPOs?

We sure do.

Who's got the most money?

Oh boy. I have so much data on this. Let's see here. So I-- oh, I don't know that I have the county, tribal. I can tell you about the tribal. For each of the rounds, we had a tribal set aside except for the last bond round, but we over exceeded the tribal allotment of the set-aside. I think it's over 200 million that we did with our tribes just for the bond alone, and I have to say with our bond round two, some phenomenal facilities that-- I know the Yurok Tribe, but actual treatment locations.

Our first few rounds were more wellness centers, but with the other rounds of BHCIP dollars, a lot of mental health and SUD actual treatment services in our tribal partners. I think our counties are around 40 to 50% of the funding. The remaining balance is for our nonprofits and then a little bit of for-profits, but those are for our social rehabilitation facilities or like a narcotic treatment program that are traditionally more for-profit entities.

And how has the funding distribution gone? Have we been able to smoothly disperse the funds after they're selected?

Yeah. So after-- so right now, for example, with the bond round two, we're in the conditional award phase. So we've conditionally awarded 66 projects, but now they have to-- we're pulling deed restrictions. We're making sure that they're meeting the match requirements. So during this process, sometimes we do have to relinquish an award just because we find out information of maybe they are doing preservation instead of expansion or their match is not valid and they don't have the funding. Issues like that.

But after, you know, that is done, then they enter into contract. I can say, because one of your earlier questions is, you know, what do we have going? What have we actually done? But to date, we have 36-- I'm sorry. There's 27 open projects that have 38 behavioral health facilities that are expanded already.

So as of right now, we have 430 beds in operation and over 4,000 new outpatient treatment slots. And that increases every day. I'm actually going to a grand opening tomorrow in Santa Barbara County for a wellness center. So we are making progress in this space. There have been some issues with cost overruns just because of inflation and things that we couldn't have predicted when we made these initial awards, but all the projects are responsible for cost overruns.

And have we done an equitable distribution geographically?

We have. We-- a few things too is, we did have with the bond, a requirement to award counties at least 1.5 billion, which we exceeded, so that was a statutory requirement, and we also had to do a tribal investment of 30 million. So we've met those requirements.

And we have a great map on our website that shows the equitable distribution because we did it geographically because we understood that some of our more rural partners may not put in-- you know, have the bandwidth to put in an application as, you know, some for-profit organization that might hire a grant writer. But you'll see across we have a really great distribution.

The only other thing I wanna say about that really quick, the LAO did a great report on BHCIP and noticed they wanted to see more in the San Joaquin area and did an evaluation of that and up north. And we have since done a lot of incredible awards. We have, as an example: Glenn County is gonna have their first substance use residential facility in the whole county.

That's great.

And then we have our first tribal peer respite with the Yurok Tribe. This is the first anywhere in the state. I don't even know, maybe the nation. I'm not really-- so we're super excited about, like, we're hitting these great areas of needs. And then we also have-- I'm really excited about this in Kern County, our first fathers with children SUD residential program as well. So we're-- across the state, we've really looked at the geographic need, but also really looked closely at access needs as well.

And lastly, how many rounds are we gonna be able to do?

So we, with our original BHCIP dollars, the 1.7 billion, we did five rounds. They were smaller. Our first was we had to do a 150 million for mobile crisis. All of that funding has been awarded.

More on that later.

Yeah. We'll talk about that later. Round two was a planning grant and we really looked through that planning grant process that was for our counties and tribes, and that's actually helped award a lot of funds later. Rounds three was launch ready, four was children, and then five was crisis. And then the bond, we had just two rounds, the first 3.3 billion and the second that we just awarded, the 1.1 billion. So all those rounds have been completely awarded.

Okay. Okay. Thank you. I have nothing else on this. We're gonna move on to Issue Number Nine, and before we get to our mini panel on this, I'll have the department first just do their presentation.

Thank you. Yes. We appreciate your questions on the 988 and community-based mobile crisis response trailer bills. I will start by providing an overview of the 988 TBL and our associated budget change proposal. So the proposed 988 TBL authorizes DHCS to establish a new statewide designation process for California 988 Suicide and Crisis Lifeline centers.

So through this process, it--or in the TBL, excuse me; we'll talk about the process in a minute--we define what will qualify as a designated 988 center, describe what is meant by a mobile crisis team, and clarify how funds from the 988 Fund will be allocated. So really, the center, 988 center designation process proposed in the TBL is meant to create a pathway to add new 988 centers while also specifying standards for all active centers in order to receive 988 funding.

And we are proposing that this process be implemented no sooner than October 1, 2027, so building in a runway and a planning process. In the TBL, we specify a designation framework and we refer to sort of basic eligibility criteria, the application and review procedures, and the duration of the approval process, but the intent is to develop the full process and the corresponding standards for designated 988 centers through stakeholder consultation if the TBL is enacted.

So to speak to our existing 11 988 crisis centers, all of them would need to obtain DHCS designation approval by December 31st of 2029, and we do look forward to supporting and collaborating with existing centers on this effort. We've gotten a lot of questions about our intent with the TBL and the pathway for existing centers and it really is that we want to create an entryway for new 988 centers so we can maximize and sustain statewide coverage and then also implement statewide standards for all centers that are receiving funding.

So speaking of those standards, we've specified that we'll address staffing requirements, training, clinical and triage protocols, performance measures for the centers, counselor service expectations, and processes for oversight and monitoring so that we are describing DHCS's monitoring and oversight role and centers know what to expect and what performance they need to deliver, so critically underscoring that our current 988 centers will continue receiving funding from the 988 Fund until the December 31st, 2029 deadline to have achieved designation.

So after December 31st, 2029, centers that receive funding will need to have that designation, but between now and that date, the existing centers may continue to function and receive funds. Also noting that we will be then publicly posting the results of this process beginning January 1st of 2028. So we will list 988 centers that are in operation, all centers that have obtained designation, and any corrective action plan suspensions or revocations that we might have to issue based on the standards and monitoring process.

So to complete this work of designating centers and also to address the growing operational demands of the 988 system, DHCS has submitted our corresponding budget change proposal, or BCP, requesting a program certification consultant, additional DHCS staffing and resources to support this work in statewide oversight, and then also requesting direct local assistance for the existing 11 988 crisis centers.

We note that we have seen consistent increases in call, text, and chat volume, and so that really points to the need for consistent statewide processes and then consistent system capacity support. So the BCP specifically requests funding from the AB 988 Fund to manage the complex and growing workload associated with DHCS's administrative responsibilities, including support of the new designation process, and our request includes first local assistance expenditure authority of 19.46 million.

Annually, this is in addition to the existing 12.5 million we have in ongoing authority. These local assistance funds are for direct support of 988 crisis center operations from Fiscal Year 26-27 through Fiscal Year 29-30. So then on the state side, we're requesting 3 million annually and that is to continue contracting with a 988 administrative entity in Fiscal Year 26-27 and ongoing. We're requesting 2 million annually between 26-27 and 29-30 for a program certification consultant to help us stand up and initially launch these designation process.

And then finally, we have amounts of 1.4 million in Fiscal Year 26-27 and then 1.37 million in 27-28 and ongoing to support eight permanent positions at DHCS that would manage the designation process and ongoing 988 workload. So we do need these resources to be able to implement the provisions of the TBL, including the designation process, and to perform ongoing statewide oversight of the centers.

And again, we also continue to emphasize-- and you'll hear from some of our 988 center partners momentarily that this local assistance funding is critical to ensure that the 988 system has capacity to manage the growing volume of calls, chats, and text, and to avoid delayed crisis response. So I will go ahead and shift to talk a little bit about the mobile crisis trailer bill and then also the questions that were included in the agenda.

So to set up the mobile crisis trailer bill, I wanna provide brief background to help explain why we're advancing this language. Under the federal American Rescue Plan Act, or ARPA, states were given a five-year window--April 1st, 2022 through March 31st, 2027--to offer qualifying mobile crisis services and receive an enhanced federal Medicaid match, so 85% federal match for 12 fiscal quarters of service implementation.

And that enhanced federal funding that was available through ARPA was always cast as temporary, so in California, we're able to access that enhanced match from January 1st, 2024 through December 31st of 2026. Our state statute that originally authorized the mobile crisis benefit sunsets on March 31st, 2027, and that was intended to align state law with this five-year limited federal authority.

So we are proposing this TBL to provide ongoing authority for the benefit beyond the sunset date. This would be at county option. The TBL also would enable us to redesign the benefit framework for community-based mobile crisis response services, and all of this would be effective April 1st of 2027 when the current statute sunsets.

So because the enhanced federal match expires at the end of this year, December 31st, the TBL does propose to continue the benefit as optional by county, with counties no longer universally required to provide the service. That means that counties that choose to opt in will be responsible for the non-federal share of costs without relying on General Fund support. Mentioned that the TBL also provides flexibility to adjust the benefit design.

The reason we're asking for that is, you know, beginning in 2027, our coverage for the benefit is no longer tied to some specific federal requirements that were attached to that enhanced match. Those federal requirements did establish a very high bar for states to offer statewide coverage that is available 24 hours a day, seven days a week, 365 days a year, no matter how rural or remote the area might be.

So any changes that we make to the benefit definition would occur in consultation with our stakeholders, and the primary area that we have heard about and will consider updating is that requirement for 24/7 356 availability, which we recognize can be particularly challenging in our rural areas that have very low response volume. So for counties electing to provide the benefit, DHCS will continue to oversee and enforce program requirements and collect data to ensure consistency and quality.

And panning out a little bit, you had a question about the crisis continuum. So want to acknowledge that the 988 system and the Medi-Cal mobile crisis services benefit are key components of a broader crisis behavioral health continuum and a broader behavioral health continuum where we are trying to improve timely access to appropriate crisis support, strengthen coordination, specifically with local crisis services, and connect individuals to appropriate follow-up care in their own communities.

We are committed to building and maintaining a crisis continuum that can realize a vision where individuals have someone to contact, so the contact point is a 988. We want them to also have someone to respond when they need help, and that would be our mobile crisis teams or other forms of timely crisis intervention.

And finally, we want people experiencing crisis to have somewhere to go, including crisis stabilization and then our full continuum of community-based treatment services. So we recognize that supporting this crisis continuum and really giving people that timely access to care requires strengthening the connection between mobile crisis services and the 988 system, especially as the state looks to leverage the 988 funds to support mobile crisis where appropriate.

So I think you are all aware that under AB 988, mobile crisis services that are accessed through calls, chats, or text to 988 may be eligible for reimbursement from the 988 Fund. We have not done that yet, and you asked whether we will have-- have or will have a method to identify and reimburse those mobile crisis encounters that are initiated through 988. We do not currently have that, but that is something we anticipate developing an approach to identify those specific responses, and that is consistent with the framework outlined in the 988 five-year implementation plan.

Our 988 in crisis strategy also emphasizes strong partnerships with other departments, and that includes regular collaboration with California Governor's Office of Emergency Services, or Cal OES. DHCS meets routinely with Cal OES to coordinate implementation of the 988 Suicide and Crisis Lifeline and the broader crisis system, while also reviewing the operational needs of our centers to understand and support their funding needs.

So DHCS works closely with Cal OES on matters related to the 988 surcharge to try to ensure the departments stay aligned on our understanding of funding considerations and can support long-term sustainability of the 988 network. Cal OES does ultimately hold the authority to establish the surcharge, so DHCS is in a consulting and informing role.

Regarding the transition of Medi-Cal mobile crisis services to an optional benefit--you all had several questions about that--DHCS has not yet completed a formal analysis of potential impacts or begun transition planning in response to specific local coverage decisions should counties decide not to cover this at county option. We do recognize that counties differ in their capacity to support the non-federal share once the enhanced federal match and General Fund support ends.

Counties also differ widely in their service capacity, demand, and other factors that might influence their decision making, and so it is really too early to determine what disparities might emerge and which counties will opt in or not opt in. I do want to really applaud county's commitment up to now to investing in and launching these services, and so, you know, given that investment to date, we do hope to see many counties continue to benefit.

The department will collaborate closely with counties to determine their plans going forward, and, of course, we want to ensure the adequate capacity exists to continue delivering timely crisis care. Last note on this, counties are required to provide other behavioral health crisis services, such as crisis intervention, so we do hope that these existing statewide crisis services can continue to support ongoing access to care, even in the event that counties opt out of the mobile crisis benefit specifically.

Right now, to support a smooth transition, DHCS is reviewing the benefit requirements to understand where adjustments or additional supports could encourage more counties to opt in or make it feasible for them to continue. At the same time, we are assessing training and technical assistance strategies and certainly welcome feedback on all this from our county partners and our providers and some of the folks you have on the panel. So we really will continue working closely on this to try to anticipate challenges, promote consistent implementation, and help minimize disruptions. Thank you.

Yes. Sabrina Adams with the Department of Finance. Some of the questions in the prior panels sort of addressed the budget deficit, and we really appreciate the continued partnership and the collaboration of this committee to address that $22 billion projected deficit and develop a sustainable fiscal plan that supports and serves the programs in our state.

I won't sort of get into a lot of the comments that my colleague at Department of Health Care Services mentioned in her remarks, but just noting that the proposal to recast mobile crisis services as an optional benefit really sort of takes into consideration the expiration of that enhanced federal match and the broader structural deficits that the state is facing and really sort of sees this approach as a sustainable path forward just given those broader budget considerations. So, yeah.

Just wanted to add that.

Thank you.

Okay. Trying to collect all my questions here. How much right now is the current surcharge?

I was gonna say, isn't it $0.05? Yes. Per--

Yes, it's $0.05 and it's on a calendar year basis, so for 2026, it's $0.05.

And statutorily, how much can we go up to?

$0.30. What are the eligible things we can fund with the surcharge?

$0.30.

Yeah. In the statute that is obviously the direct operations of the 988 response centers and then mobile crisis-- qualifying mobile crisis responses, which we mentioned need to be those that were routed through 988, and then there is state administrative responsibilities that can be covered today.

So, could we cover some mobile crisis units with 988 surcharge revenue?

Yeah. To your earlier question, and then I'll let Ivan chime in if I missed anything about the way the statute is structured, we can identify a mechanism to know or identify which mobile crisis responses, right, originated through 988, and once we do that, the statute would allow us to use the 988 Fund too to fund those.

Sure. So, TBLs have amended statute many times. Is it-- option--not saying, I'm just saying-- is it allowable to further define what kind of mobile units would be-- could be eligible to get funded under 988 surcharge?

Certainly could be written more broadly, if that's your question.

Will, did you wanna add some to that?

Yes. I would just like to point out that, happy to work with your staff, but also would like to point out that any type of TBL expanding that may also need to be looked at conforming changes within the statute that allows OES to what they factor into setting the surcharge amount.

Okay. Thank you for that. And will we need to increase the surcharge with the request that is being asked in this BCP or is the current fund cover what is being asked for?

That's the question I think we would have to defer to Cal OES.

Okay. But you wouldn't-- I think you would need to know, right? If you're asking here in BCP, you would need to know if you have the funds for it.

Yeah. So in statute, statute outlines that Cal OES sets the key by October 1st of each year and Cal OES uses a statutory calculation to sort of consider the fund balance that's existing in the fund and sort of what the authorized expenditures are for the following-- for the fiscal year and they set the fees so that revenues are generated to support the level of authorized expenditures in the Budget Act.

So, like, depending on sort of what is authorized in the 2026 Budget Act, there could be-- there could-- yeah, in October, there could be a need to adjust the fee, but it would be in accordance with what's approved through the Budget Act.

Since you're in a consultation relationship, has there been consultation with Cal OES, given that this BCP is being proposed?

Yeah. And Ivan, you may want to elaborate, but I think we do regularly share information about the identified costs of the 988 center, right, which is what informed the estimate and the specific amount requested in the BCP. So we'll continue to communicate about that with Cal OES as we proceed.

Okay. I'd be really interested in a more direct answer, if you can share of-- in the consultation. Is there already an anticipation of an increase in surcharge to cover this BCP? I would have anticipated or I would have hoped to know that Cal OES would have understanding if the current funds covers it now or if we would have to increase the surcharge into what we would have to increase should this BCP pass. If you can get me that information shortly after this, that would be helpful. Deputy Director.

Deputy Director? Yes, Deputy Director. You-- in your response to number two, you shared--and I get it; that's in conjunction to what Department of Finance responded to--but you shared-- the language you met, you said it's, like, we're in commitment. We are fully committed to the two pieces: someone to contact and how will someone respond to them. Step two is crucial. It's a bit of a dissonance there that we're in commit-- we're committed to this but we're not even further investing into step two.

Step two is a crucial part of what the department is saying that they're in commitment to. So disconnect there, I'm feeling. I think it's hard to say we're fully committed to this, but we're no longer gonna make this a fully covered benefit, and step two, I think, like I mentioned, is a crucial part to getting the continuum of care. I think we're fracturing the continuum of care here.

I'm also wondering how we look at-- $150 million of investment in the non-bond BHCIP for round one went into the infrastructure of this. Are our taxpayers now gonna say it's a waste of money because we invested to create an infrastructure that we're no longer gonna fund? Is that looked at as a waste?

Yes. I think, really understand and appreciate those concerns and would refer back to what my colleague from Department of Finance said, which is, you know, these decisions are made sort of looking across budget and spending priorities, and this is the proposal at this time.

DHCS certainly is committed to working with counties to figure out what are the avenues for both continuing these services and then strengthening the additional crisis response services that we mentioned that will continue to be required under Medi-Cal so that we can maximize whatever resources we can.

Would you be able to respond to the principal question, the core question of the state invest in an infrastructure of xyz program for us to cut it at the knees regardless--we don't have to talk about the mobile crisis unit--but regardless of our program? Is that a waste of investment then? We've invested so much money into creating, uplifting, and infrastructure to not fully continue with it.

Department of Finance, is that a waste of our money? And not just talking about this program; any kind of investment we make for building infrastructure. Would-- is this--

Yeah. I think-- and I noticed you're asking our county partners also to speak to whether or how they're able to sustain that investment, so I think, again, we hope that they will be able to, that those were, you know, start up and infrastructure funds, that we will find ways to carry forward, but certainly understand the concern.

And I brought this up, Deputy Director, last hearing. We are not absorbing a single thing that the federal government cut from us, not one thing, and we want the county to absorb everything we're kicking them off. I just wanna make that clear that everything that is Sub Three, we have said no to funding that the federal government cut from us and are hoping the county will continue all of it. And we haven't taken on a single thing that the federal government has cut from us.

That's, again, a bit hypocritical from us to say, I think you can do it, county, but we're not doing a single one of them. It's just-- it's hard to say, county, I need you to be a partner with us when we haven't taken on-- and not just in your department, madam. It's just overall in Sub Three, it's hard for me to say, county, do it all, when we aren't coming to the table and say, we're gonna do part of it.

So that's just an overarching theme that I've seen this year under Sub Three. All right. Back to my questions. Can I get clarity on-- the funding was until, I said, March 31st, 2027 for the mobile crisis, but it ends this year, the funding?

Yeah. There are two dates and it is a little confusing. So the enhanced federal match for the mobile crisis benefit is available through the end of the calendar year, so that ends in December, but the statute that originally authorized the benefit sunsets at the end of March because the way the federal legislation was written was there was, you know, a five-year authorization period and then there was also-- is it 12 quarters of enhanced federal match, which states could be on slightly different timelines depending on when they launched the benefit.

Okay. Okay. Thank you for that. And then how much-- I was trying to find the dollar amount. So it's 85% match from the federal government. How much are we putting into it?

Historically or potentially going forward? So historically under the-- yeah. I would need to defer to Department of Finance for that.

So the 2022 Budget Act authorized one-time funding of 1.4 billion General Fund over five years for mobile crisis through March 31st, 2027.

And that's just all in the General Fund?

Correct.

1.4 billion over five year, whatever that math is. Okay. And we have funding until December. Is there any numbers of how much to fund until-- I just, I'm curious. I'm just curious. If you can get back to me? That's half of the fiscal year. Is there the amount it would cost to fund it until June 30th?

So we have-- in the current budget, right, assumes the enhanced federal match continues through December and then there is a three-month period until that March 31st state where the budget proposes use of 988 funds.

Oh, so it does propose? I apologize. So it does propose-- so that's where I'm getting the April?

Yes. And then technically, you know, without the TBL, the benefit would sunset as of April 1st.

Okay. So then how much is it for the three months? Do we have numbers of how much it would cost to fund for the last three months of the fiscal year? Two months, I guess. May and June. And if not now, if you could share?

We can see if we can follow-up with that information.

Okay. All right. And then on the crisis centers, couple questions. Let's see if I understand this correctly. Is it that the crisis centers-- or so the crisis centers support their total funding needs for operation is $105 million. Do they feel like they're underfunded? Because then the department says you have 12.5 million local assistance appropriation for the centers but the centers say their operations are 105 million?

So our current funding request is based on current capacity, and I believe what their funding request is inclusive of is being able to target greater answer response rates across calls, chats, and texts.

So they're saying that they're-- we don't-- they don't have the capacity to meet all the need?

They have the capacity. So our funding, again, is consistent with what their current capacity is and what they're suggesting is essentially to grow, to meet the growth volume over the next, you know, fiscal year and also to be able to meet answer rates at target rate that is expected from SAMHSA which is greater than 90%. Their funding request would be consistent with that and also their response times.

So right now, SAMHSA mandates that across all contacts--so chats, texts, and calls--the answer response rates have to be greater than 90% for 15 seconds. So responding within 15 seconds and then 95% would be 20 seconds.

Okay. So they would like to be able to meet MSAs requirements or--

SAMHSA's, yeah.

--guidance?

Exactly.

Oh, SAMHSA's, sorry. Guidance, but the work load has still increased for the BCP need of the positions?

Correct. Exactly. And our funding request--

--takes more into account.

But they haven't grown?

What was that?

Our funding request also takes into account a little bit of that growth, and so we're providing more funding than we have in the past.

Okay. So the funding increases because of their growth, but they haven't grown to the point where it's at the full SAMHSA guidance?

Correct. Yes.

Okay. And will the positions allocated here help them grow to that level?

The funding-- so the positions that we're requesting are for state operations, so those are for DHCS, and then the local assistance funding, which is about 19.46 million plus the 12.5 million in ongoing costs, that's specific to the centers, and that again is intended to meet their current operational capacity.

No, but I guess-- I know the positions for the department, but would those positions help them meet their full growth?

I think the positions will help us stand up and implement the designation process and also do the ongoing quality monitoring. So I think those positions will help us do things like identify that process to monitor mobile crisis encounters, right, that result through 988. It will help us monitor their performance on the indicators that Ivan just talked about, give us better data and better oversight effectively.

Okay. And then why-- I'm just curious. Why isn't there a center in LA?

There is a regional center, Didi Hirsch, that supports the Los Angeles area.

Okay. This-- okay. Yes. Century City. There we go. Thank you so much. My roster's missing counties, that's why. Okay. And then my other-- whatever my last questions are. Is-- Deputy Director, like, what do you anticipate or what do you anticipate will happen if the mobile crisis units aren't funded?

I think what, you know, the best-case scenario, right, is people and communities are resourceful and there have been over the years other investments in mobile crisis response through EMS, through law enforcement, et cetera, so we have-- you know, we do have a lot of--

Units are to prevent from law enforcement to go, right?

Yes.

Okay. So it can't get to law enforcement.

It's not interchangeable. Thank you. Yes. So, you know, to answer your question, I mean, I think we would hope that there will be ways to continue funding this response, and we will also need to look, as mentioned, at other crisis services and continued investment in those services.

And we will need to monitor, right? Are we seeing indicate-- performance indicators that are concerning, increased use of other crisis services, increased hospitalizations, et cetera? And those are the kind of things that the state can take into consideration in the future as we look at how to prioritize funding and where to invest in our system.

Okay.

And also just noting that, for those counties that do not opt in to the mobile crisis benefit, they would still be able to continue to build crisis intervention services.

Okay. Thank you. The last thing I'll know is, like, I keep saying these stuff. We do all these plans and we don't turn to them, you know. The CalHHS, we did a plan, the Building California's Comprehensive 988 System, a strategic blueprint to tell us how successful we can be, and that's one of the recommendations. I think it's-- I mean, we tell ourselves how to be successful and it's-- we don't follow through with it. You know, it's to reduce unnecessary law enforcement involvement where possible and connect it to a crisis care continuum. I mean, those are two of the four plans that we said that we wrote into this blueprint.

So, if there's a way-- I mean, I'd be really interested of the surcharge. I know the general-- I get we can't turn to the General Fund. I get that, but if there's opportunities where we can turn to a surcharge, we have $0.25 left in the increase that we can go to, and if there's an avenue that we can turn to-- not every program has a potential revenue stream that you can turn to.

And if there's a potential revenue stream we can turn to to save mobile crisis from making sure it's a covered benefit, I'd love for us to look at that as an option. Okay. Thank you so much. Oh, wait. Nope, I already asked this.

Thank you. Now we'll bring in our county partners to share some insight on the same topics we're covering. And the providers, yes. So we have Lake County Behavioral Health Services, Behavioral Services from the County of San Diego, Seneca Family of Agencies, Sycamores, Didi Hirsch from LA, and the Crisis Support Services of Alameda County.

So we'll start with Director Jones.

Oh, we are live. Alright. Thank you, chairman of our appreciate the opportunity to speak today. Of course, you know my name is Elise Jones. I've been serving as the Director of Lake County Behavioral Health since the fall of 2023, which in dog years, is a long time.

I joke about that. In Lake County, we're a population of about 67,500 people, 68,000. Very rural, big lake in the middle of it, very hard to get around. Unfortunately, we don't have a ferry that goes across the lake at this time. Although, that was an idea of our mobile crisis team.

We currently operate one county operated mobile crisis team. We are on staff twenty 24/7, 365 days a week. That is a team of a minimum of two people responding. We also have our own dispatcher, if you will, to route calls. In calendar year 2025, we received approximately 5,064 crisis calls and we conducted 1,305 field responses.

About 83% of those field responses were resolved safely in the community without needing a higher level of care. That means people were stabilized through de-escalation, clinical assessment, safety planning, linkages to services, and follow-up without defaulting to emergency department, hospitalization, or law enforcement response. We did receive $1,000,000 in the crisis, the B Chip Crisis Care Mobile Unit Grant, and that was critical for us.

It allowed us to purchase two vehicles, support staff salary prior to being able to draw down reimbursement, conduct public outreach, and for the first time ever, our department actually was able to put up a couple bill billboards to spread the word which was great. I wanna be careful about the definition of mobile crisis.

Mobile Crisis is not just the moment that the team arrives in the field. Under DHCS guidance, it is a clinical crisis intervention that includes assessment, de-escalation, mobile response when appropriate. If we can't deescalate over the phone, which we do successfully a lot of the time, by the way. Crisis planning, warm handoffs, referrals, and follow-up. If we wait until somebody meets 5150 criteria or is already at the highest level of acuity, we have missed the opportunity for mobile crisis to do its job.

This is also why 988 integration matters. 988 is an important front door, but it does not replace the local response system behind it. In Lake County, 988 calls are routed through our contracted crisis line and triage for response with escalation to mobile crisis or law enforcement when needed. But we continue to see rural challenges, low and inconsistent 988 call volume, Geo Routing issues with smaller carriers, limited data visibility, and gaps in coordination between 988, 911, and local mobile crisis.

We are also concerned that mobile crisis may increasingly be used for only higher acuity dispatches that would undermine the preventative role of mobile crisis and make the system more reactive.

The broader budget context matters. The agenda recognizes that California is investing in 988 crisis centers while also proposing to repeal the statewide mobile crisis benefit and transition it to a voluntary county funded service. That is strengthening the front door while weakening the response system behind it. At the same time, the state continues to invest in the deepest end of the system including State Hospitals which we heard from earlier today. I understand those investments are critically necessary.

And yet hospitals re represent the end of the treatment line of continuum. If we cut or destabilize upstream crisis response, we should expect more downstream costs. More emergency department use, more law enforcement involvement, more hospitalizations, more conservatorship pressure, and more demand on state systems. For Lake County, shifting mobile crisis to county responsibility would create immediate sustainability risk. Ensure we could not afford this.

And we would have to divert back to pre mobile crisis days where we only respond to 5150 calls when needed. With a very limited designation. It's also notable that the rate that's being referenced by DHCS for that specific service is much lower than the rate for the mobile crisis benefit. So Lake County's request is simple. Maintain statewide support for mobile crisis, strengthen 988 to mobile crisis integration, and support rural flexibility which does not preclude like you can still have this benefit with flexibility.

But saying that you hope counties will continue this benefit in the absence of a requirement, I cannot pay bills with hope. Thank you very much.

Thank you so much, Director. Now we have the Director from the County of San Diego's Behavioral Health Services.

Thank you for having me here today. My name is Nadia Pravara. I'm the Director of County Behavioral Health in San Diego. Health in San Diego. In 2019, our clinical teams worked with our Sheriff, District Attorney, and other stakeholders to develop to develop our mobile crisis response model.

We all saw the urgent need for responses tailored to people in crisis to improve care pathways and reduce law enforcement involvement and emergency department utilization. In 2021, our first two mobile crisis teams started only in our North Coastal region of our county. Later that year, we saw the early success of the program and we were awarded $18,000,000 to of BCHIP funding, to add 18 additional mobile crisis teams and expand our services countywide. The mobile crisis service also became a MediCal benefit.

Signaling to us the state's commitment to sustaining these life saving services.

Locally, we took the opportunity to continue expanding the services into our K through 12 schools, colleges and to universities. And over the last eighteen months, they have responded to over 600 calls on school campuses to support children in crisis and connect them to ongoing care. Without these teams, law enforcement would have responded, which often escalates and stigmatizes students. Our teams are also building rapport and responding now to tribal communities.

We now have 44 mobile crisis teams which are primarily funded through MediCal State General Fund at a cost of $24,000,000 a year.

About 85% is covered as, they mentioned through MediCal with the other 15% covered through State General Fund. We also cover, costs for uninsured clients, who use the services as well. Since inception the teams have responded to more than 32,000 calls with 98% receiving a response in less than one hour. Mobile crisis teams are essential with when our children, neighbors, and loved ones are experiencing psychiatric crisis. The Clinicians and peers are skilled in deescalating crises in the field with only 2% requiring law enforcement intervention.

Half of all calls that we receive at in a field intervention are stabilized in the field. And our program is focused on supporting medical beneficiaries with over 80% of the clients being medical eligible. Mobile crisis services are also an entry point into the system. Nearly 60% of people serve through these crisis services receive a behavioral health service within, thirty days. Additionally, they also can determine if somebody meets a involuntary hold criteria with about 16% of interventions resulting in a 5150 hold.

But the community benefit is so much larger. Over 80% of the encounters are diverted from costly emergency depart visits. Our law enforcement partners benefit as well. About 18% of the mobile crisis referrals are diverted from law enforcement intervention. So law enforcement officers instead are be able to respond to real emergencies.

Since 2022, we have also leveraged the 988 line to support mobile crisis response. Community members can dial 988 and connect with our local access and crisis line, which works directly with the mobile crisis teams to dispatch services. Our teams are truly integrated within our local network, delivering efficient, compassionate, crisis care to people where they are. So what happens if the mobile crisis team becomes optional county loses counties lose state funding? In San Diego, it'll force us to significantly scale back our crisis teams impacting our entire system.

With the shift of MediCal Percentage from 85 to 50, we will lose revenue of approximately $15,000,000 a year including about $10,000,000 in Medi Cal and about five and a half of State General Fund Dollars. And the impacts of HR 1 when those begin to hit there will likely be additional uninsured individuals that also use our mobile crisis teams as their benefits are lost. Our county cannot absorb these costs and maintain the existing capacity. Making the optional benefit, optional moves our system backwards.

It'll undo the progress we've made to improve access to care and reduce barriers.

It will undo the crisis services that support our schools when we know mental health concerns are drastically increasing. It will undo our efforts to reduce unnecessary law enforcement involved, contacts, likely increasing adverse interactions and potentially abandoning people in crisis when calls go unanswered. It'll also undo our progress to decrease unnecessary use of emergency departments. And it's going to impose new strains on our already burdened system by increasing the use of our own crisis stabilization units and crisis walk in clinics.

Mobile crisis teams are a regional asset and argue arguably the most effective behavioral intervention health intervention that we've implemented in recent years.

Over the last five years we've been a leader in implementing these teams. And they are fully integrated into our system. They should be prioritized as a MediCal mandated MediCal benefit with State General Fund and MediCal dollars. So we hope that these will be sustained long term. Thank you for your time today.

Thank you so much. Go to Chief Strategy Officer from Seneca Family of Agencies.

Good afternoon, Chair Menjivar. My name is Emily Allison, and I serve as Chief Strategy Officer for Seneca Family of Agencies. Seneca is a non profit that has helped children and families through the most challenging times of their lives for more than forty years. We provide comprehensive behavioral health, education, and child welfare services across 19 counties in California.

One of the most crucial ways we do this is through our mobile response services in three counties, which responded to over 1,400 crises by phone and in the community last year alone.

For over twenty five years, our mobile crisis teams have helped young people and their families navigate profoundly difficult moments. We were there for Anna, an 11 year old foster youth whose grief, loneliness, and separation from her family had become so overwhelming that she began talking about wanting to end her life. Working with Anna and her resource parent, our bilingual Clinicians helped stabilize the crisis at home and created a plan to support her safety and connect her to ongoing care.

Our team responded to Nina, an eight year old girl whose trauma from witnessing extreme domestic violence was triggered during the school day, leading her to hide under a desk, scream, and strike out when adults approached. Using play, patience, and trauma informed support, our team helped her feel safe enough to reengage, and worked with caregivers and school staff to plan to reduce future crises.

And we were there for Damien, a 13 year old foster youth whose caregiver feared the placement was about to disrupt after repeated nighttime conflicts, threats to run away, and escalating emotional distress. Our team helped deescalate in the moment, supporting both Damien and his caregiver, and built a plan that made it possible for him to stay safely in the home while his child and family team developed a longer term plan.

I'm here today to advocate for kids like Anna, Nina, and Damien, and to strongly urge the legislature to reject the proposal to make mobile crisis an optional benefit. This vital service connects young people in crisis with teams of highly trained professionals who can respond in the community, deescalate safely, and connect youth to the care they need. Children are not just small adults.

Their crises are different. Their developmental needs are different. Their family dynamics are different, and their service systems are different. Guidance from SAMHSA and the American Academy of Pediatrics clearly states that effective response for children requires specialized teams that understand youth development, caregiver and family engagement, school and child welfare systems, and how to stabilize a crisis in a way that protects long term well-being. If this benefit is made optional, counties will have a much harder time sustaining specialized children's teams, let alone with 24/7 support.

And in many places, especially rural counties where these services are needed most desperately, mobile crisis teams may completely disappear. That would be a devastating loss. We should be moving towards more community based, specialized, and developmentally appropriate crisis response for youth, not away from it. This proposal would also have a direct impact on foster youth who receive mobile response services through the family urgent response system. Last year, 23% of Seneca's mobile response services were provided to FERS eligible foster youth and former foster youth.

Seneca is the first provider in the counties where we provide mobile response. This is not coincidental. The integration is what makes the model work. FERS funding on its own is not sufficient to sustain the infrastructure and staffing required for 24/7 community based crisis intervention. If mobile response is made optional, FERS will be impacted too.

For foster youth and caregivers, that will mean less support in critical moments when a young person's placement stability is at risk. We know that mobile response works. It's a proven prevention strategy. In Seneca's longest standing mobile response program, we stabilize 86% of young people who receive an in person visit, diverting them from a potentially traumatic ER visit, inpatient psychiatric care, or law enforcement contact.

We also provide follow-up support, connect youth to ongoing services, and help them step down from higher levels of care, often for thirty to sixty days following the initial crisis or referral.

This is one of the most important prevention tools we have, reducing reliance on settings that are more restrictive, more disruptive, and more expensive. Cutting mobile crisis response does not eliminate crisis. It just shifts the cost and management of behavioral health crises to county systems who are already struggling with the financial constraints already discussed today. It also shifts the cost in management to resource stretched law enforcement agencies and emergency rooms that are designed to address acute physical health crisis.

California has made such extraordinary progress building out this critical part of our community based crisis continuum, and we cannot go backwards now.

I respectfully urge the legislature to reject this proposed change and maintain the statewide mobile crisis benefit. For young people and foster youth in particular, mobile response is not optional. It's one of the most effective and important programs we have in California. Thank you.