Assembly Budget Subcommittee No. 1 on Health

Good afternoon. I'm gonna call this hearing to order. Committee staff, if you'll please call the roll.

[Roll Call]

Thank you. We are gonna start as a subcommittee, and I wanna welcome everyone and thank you for your patience. This hearing today is gonna cover behavioral health and will include the Department of Health Care Services, the Department of State Hospitals, the Commission for Behavioral Health as well.

And we have a couple of housekeeping notes before we begin. You can find the agenda online on our committee's website and physical copies are available in the hearing room.

We're in Room 126. We will also ask panelists representing the Department of Finance and the Legislative Analyst's Office to sit at the edges, if needed, of the witness table to make room for other witnesses. And after each panel presentation, we'll take questions from Members followed by public comment.

We are gonna keep public comment to thirty seconds name, organization, and your position on the item that we're discussing or the issue that we're discussing. But again, we're gonna keep it to thirty seconds.

So when you come for public comment, you can say your name, your organization, and your position on the issue or the item. All public comments will be taken in person at the end of each issue. And then for items not on the agenda, we'll take that public comment at the very end of the hearing.

If you are unable to attend in person, you can submit written comments to via email to [email protected].

So we are going to start with issue 1, which is through the lens of Anosognosia, HR 1, and the future of behavioral health services.

And if you don't know what Anosognosia is, you're gonna learn a lot during this issue and during this panel. I would say it's one of the more important or most important things for us to discuss when it comes to hard to treat mental illness.

And this is an issue of personal importance for me over the past, few years that I've been in office. I've heard from multiple families that I represent whose loved ones are living with hard to treat mental illness.

One of those is Anosognosia, and it's a neurological condition that prevents individuals from recognizing that they are sick.

Prevents people from recognizing that they have mental illness, which makes this exceedingly challenging to get treatment. And I've heard from families directly, some of whom you'll hear from today.

Their stories are both humbling as well as clarifying, and they've shown in very real human terms the heartbreaking story of how California's behavioral health system has many gaps that we need to address.

And I'll also talk about the cost of our mental health system reaching its limits and not serving every person that our system is meant to serve. The share of California adults with serious mental illness increased by approximately 50% from 2008 to 2019 with young adults seeing that shared nearly double over the same period.

So we know this is serious in California and more than one in five California adults has a mental illness with less than 80% of them receiving treatment. So there's a significant portion of the population who have yet to receive treatment.

As you all know and as as this committee knows, these figures represent real people who have been cycling through emergency departments, psychiatric holds, jails, crisis settings, care courts, and other kinds of programming without being able to achieve lasting change.

And while California has made significant investments in behavioral health in recent years, we definitely need to continue. But what we're facing right now with HR 1 is going to take us backwards because of the significant reduction in medical dollars.

We know that funding to counties is not going to come in the way that we have become accustomed to and frankly in the way that our communities need it to. And we know that providers are not gonna be able to provide the same level of service because of HR 1.

So today, this this subcommittee has invited families impacted by NSOgnosia to share their experience and a number of county and provider experts are also here to help put those experiences in a broader context and talk about both what's working and what's challenging and what we need to be doing from a

budget perspective. This is the beginning of a conversation. It's certainly not the only or the end of a conversation.

This Friday in district, I'm holding an additional forum in my district about this same issue, hard to treat mental illness through the lens of Anosognosia where we'll have practitioners and people in the field as well as families come to talk about this issue and look at what we're getting right locally, what the challenges are, and what we may need to do at a budget level.

For those who are interested in watching that panel, it'll take place at 10AM at the San Luis Obispo City Hall this Friday, May 8, and we'll be live streaming that at addis.asmdc.org. And I invite all of you, to join in with us and to watch that, and we will be trying to take questions from the audience there as well.

So I also wanna take a moment to thank the families who've traveled to Sacramento. They did my commute today, which is four and a half hours up, four and a half hours back home, and say thank you so much for your patience.

To every witness who's come today, thank you for your patience as we finished a long floor session today and appreciate you being willing to stay and know that you have big travel ahead of you. I also wanna say that, we all understand.

I don't wanna speak for my colleagues, but I know them well and I know their hearts that we understand the bravery that it takes to come and speak openly about the hardest moments in your lives and about the people that you love and to divulge very personal things.

Here in an effort to help the greater state of California, the 40,000,000 Californians understand not just what you're going through, but what the state can do and what we can do through the budget to potentially make some movement in this area. And so I want you to know that each of us are listening.

So we have Dawn Marie Anderson on behalf of several families impacted by anosognosia . We also have doctor Leandra Clark Harvey, chief executive officer of the California Behavioral Health Association.

We're here to work hard on your behalf, and I think we're all committed to making the health care system in California better, and that includes our mental health and our behavioral health system. So we're gonna move into the first panel, and I'll welcome our panelists up to the table.

We have Antoinette or Tony Navarro, director of behavioral health wellness from the county of Santa Barbara, and we have Michelle Dodi Cabrera, executive director of county behavioral health directors association.

I wanna thank all of you for being here. I also wanna note that the Department of Health Care Services, Department of Finance, and LAO and the Legislative Analyst Office or the LAO have been asked to be available for technical assistance and questions. So I will turn it over to you.

I think we're starting first with Dawn Marie, then we will move second to doctor Leondra, third to Tony Navarro, and fourth to Michelle Dodie Cabrera.

Go in that order of testimony, and then there will be time for questions, from the Members, and then we will turn that turn it over to public comment.

And please begin when you're ready.

Thank you, everybody. And I don't even like calling it a subject because it's so humanly, deeply needed. And right now, May has been coined the mental health month. And mental health month is a good thing, but mental illness is not mental health. They're two different places.

They're they have requirements that are more extreme than mental health does. Mental illness really deserves the medication that helps them stabilize long term, not just because they're stabilizing. Now you think they can make better choices. I'll read my story and you might understand more.

My name is Dawn Marie Anderson. I have been asked today to share my story and the need to understand what Anosognosia is and how it is real. The lack of insight to an illness, brain disease. How do you get something to work when it's got an illness? You don't throw somebody with a heart attack aside.

Since 1998, my son, who is now 42 years old, has struggled with severe mental illness for more than 26 years. He lives with schizoaffective disorder, grandiocios personality disorder, and was born with autistic markers.

But was made but what has made all of this even harder, something made people still many people still don't understand. It's called anosognosia, a symptom of the illness. It means he does not know he's sick. His brain will not allow him to understand that he needs medication.

So I want to ask you a question. Would you ask a blind person to try to see harder? I have spent decades living with the nightmare, cold rainy nights searching every corner of Bush just to find my son, make sure he was still alive. I have seen him starving without blankets, tents, or shelter.

There's a knot in my heart that has not loosened for many years. My son has been homeless on and off for years. He has been arrested for misdemeanors at least 200 times in the same county. At one point, I found myself begging the police to arrest him just so he could get help.

No mother should have to tell her son she loves him and then call the police to have him handcuffed so he could go see a doctor. And when that happens to you and you say, okay.

Now you need your medication and you're sitting in a cell, what would your answer be? The system treats this like a criminal issue, not the medical issue it truly is. My son has been declared incompetent to stand trial 12 times.

Each time he sits in the jail for months, even often in solitary, unmedicated, and in psychosis. This is not treatment.

This is suffering. Eventually, he is court ordered for more forced medication long enough so he can understand court ordered paperwork. He stabilizes his court order to be have a program begins. It's based mostly on drug and alcohol. When the program ends, the support ends.

The charges are dropped. The system calls it a success. But for someone with Anosognosia, that success is a cliff. He believes he is fine, so he stops the medication. Within weeks, things fall apart again.

He loses his housing, his work, his stability. He's back on the streets and the cycle starts all over again. I would try to remind him back in the day before I knew about anosognosia and this book that he needed his medication, but his brain would not accept it. He would feel threatened, get angry, and disappear.

The cycle begins again. Homelessness, unmedicated, and back into deep psychosis. Then I would call for help. I would be told, he'll come back if he wants help, but we know he won't. His brain tells him he's not sick. Drugs and alcohol programs do not work with a person with a mental illness.

The illness should be addressed immediately. This should happen on the first break of an illness. This can be the difference for the rest of their life even with Anosognosia. And way too often, the staff will tell the person they have rights. There's truth to that, but let's save it for a healthy conversation.

When my son is on medication, he is a completely different person. He's a builder. He works hard. He earns money. He creates a life.

He's proud. He's kind. That's who he truly is. But the system mostly sees him when he's unmedicated, homeless, and in a crisis, expects him to make choices we know he cannot make. My son has been through the state hospitals and jail based programs across across California 12 times.

12 times the same diagnosis. 12 times the same treatment. 12 time starting over. Think of the expense, not only for the families in his life, but the cost that's costing everybody. His diagnosis is always the same.

The treatment programs are the same. A diagnosed brain disease we know is not gonna go away just like a cold. He never asked for this illness. He should not have to break the law to get medical care that keeps him stable and gives him dignity.

One time at the jail when he's finally stabilized and will see me, which takes months and months of jail stabilization sometimes, he asked me, why does this keep happening to me?

And he was scared. What could I say? Take your medication? That didn't make sense to him. I have seen small signs of hope in our San Luis Obispo County.

People are starting to work together differently. Our even our district attorney, Dan Dow, has listened. In June, he held a forum addressing our SMI population and their families. There were 34 heads of our county and city mental health departments involved to hear our stories, discuss the uses of ROIs,

rights of information, provide SMI navigators, a goal we hope it will happen soon, allow family members that are involved to be more involved, and have faster action towards medication. There are conversations happening, and this matters.

Recently, for the first time, a team recognized that my son was not ready to be released when the program ended. They advocated for more time. That helped. And that team was a public defender, a district attorney in the jail doing that, and it worked.

The judge kept letting him go back to court three extra months, and that helped so much. Today, my son is in his twelfth month of stability. He is medication compliant. He likes his team. He is working with outpatient programs. He is happy, and he is living with me.

We have an outstanding relationship. Don't talk about medication. I don't talk about mental illness. We just talk about life and everyday stuff. Whatever his team's doing over there with the AB 1109, it's working, and I'll let them do their job.

My son and I have a relationship. First time ever. It should not take twenty five years and 12 cycles through a system to get there. And we have to talk let's talk about Care Court. Care Court 's a voluntary program that those with Anosignosia, are they gonna agree to go to Care Court?

Would they even agree to go to the courtroom? But how can we expect someone volunteering for a treatment when their brain tells them they're not sick? That's what Anosognosia is. This is the piece that's missing. Anosognosia is not denial.

It is not stubbornness. It's a part of the illness. Until we acknowledge that, we will continue to fail people like my son. Many people working in this field do not know what Anosognosia is. This has to change.

My story is one of thousands in California families who are doing everything they can to keep their loved ones alive, often at tremendous emotional and financial costs.

We are not asking for perfection. We are asking for a system that recognizes this is a medical condition and respond with consistent ongoing care, not short term fixes. That end the moment someone appears stable, which brings up a point. Housing without treatment does not work.

With the time allowed, this is a very compiled short part of my story. I can provide other dozens of families that are willing to speak just in our community. My dear friend, Jackie, her story is also horribly heartbreaking and ongoing.

We started working together and walked around our county to staff anyone that would listen. We took this book, our foot in the door. I'm not sick. I don't need help.

Where am I? We gifted it to whoever would take it. People read it, wish they had it years ago.

It teaches you what the word anosognosia means, teaches you how to say it and its meaning. And Jackie and I would much appreciate the opportunity to speak further with any of you. I have provided a handout on anosognosia along with some resources and my email.

If you want my phone number, please see me before we leave. Thank you so much for listening and considering how you can be a difference and make changes, But we can't do it alone one person at a time.

We have to work together so that we can agree and make some agreements that will spread around all of California so that we have some consistency. Right now, counties are using their own ways with the what we've got to offer.

But if we can make some consistency and build strength, we can help our loved ones that are lost, not on their own accord. Thank you so much.

Thank you. Please welcome. Good evening.

I was gonna say good afternoon, but we are past that. Thank you so much for holding this hearing and for this really important topic. It's one that's not discussed often. I'm Dr. Le Ondra Clark Harvey. I am the CEO of the California Behavioral Health Association.

We represent providers that serve over 2,000,000 Californians. We are diverse collective of organizations. I'm also a psychologist and I've treated many people with Anosognosia. Where did I treat them?

In correctional facilities because that's where many of these folks end up, unfortunately. So families and providers, we've just heard from a wonderful example, and thank you for sharing your story.

They already know that this lack of insight is a clinical symptom of serious mental illness. It's not refusal of care. It's not a lack of willpower, and it's not a reason to deny access at all. Anasignoja, as we've heard, is a neurological condition.

An individual is unable to recognize that they are ill. This is not denial. It is not noncompliance. It's a symptom of the illness itself. I've read so many notes and consulted with colleagues in past years who have said it's noncompliance.

It's denial. It is not. Yet our system still treats it as if it was an actual choice for a person. You see, we've built a behavioral health system that assumes that people can identify their need for care, consent to treatment, maintain coverage, and navigate very complex systems.

Individuals with anosognosia often cannot do any of those things. And we're seeing the consequences of that mismatch every single day. Providers are regularly seeing individuals who are cycling through emergency rooms, psychiatric holds, incarceration.

They are unhoused, they have short term stabilization, and then they're discharged without lasting continuity of treatment. That's not a failure of individuals. It's a failure of system design.

A person may appear temporarily stable, lose access to care, and then return only after another preventable crisis, often sicker, more destabilized, and more costly to serve. We're not interrupting the cycle. We are financing it.

California's behavioral health system still responds too often at the point of crisis. Instead of consistently funding long term treatment engagement, housing supports, and sustained recovery services.

And individuals with the most serious needs continue to fall through administrative gaps between managed care and county specialty behavioral health systems, gaps that function in practice as delays in care until someone decompensates.

For someone with anosognosia, those gaps are not bureaucratic. They are dangerous. Every missed handoff, every eligibility lapse, every discharge without real connection to ongoing care increases the likelihood of hospitalization, incarceration, or homelessness.

That's why anosognosia makes the case so clearly for no wrong door system.

And for this population, access to care cannot depend on insight, compliance, or perfect navigation. When some1 shows up, an emergency department, a jail, a clinic, a street outreach encounter, or through a family member.

We must determine how to engage them, not whether they qualify for help. A no wrong door system means the system takes responsibility for connection and continuity, not the individual who is least able to carry it. HR 1 raises some serious concerns in this context.

If medical coverage is reduced or disrupted, we should be clear about what happens next. People don't disappear, but their coverage does, and they show up later, sicker, and in crisis. That's not cost savings. That is cost shifting.

And it is more expensive and it's more harmful. So for individuals with Anosognosia, even short disruptions in coverage can completely sever fragile treatment relationships.

Community behavioral health providers are already operating under workforce shortages, inadequate rates, and rising demand. Federal instability will not trim the system. It will destabilize it.

We feel strongly at CBHA that California should act now to simplify eligibility renewals and eliminate procedural disenrollment so people are not losing care because of paperwork.

We must preserve access to medical behavioral health services, particularly for individuals with serious mental illness and substance use abuse disorders.

And in closing, we must continue to invest in what we know works. Assertive community treatment, mobile crisis response, supportive housing, medication support, and intensive community based services that are designed for people who cannot self navigate care.

Early intervention and sustained engagement are not just better outcomes, they are smarter public policy and better stewardship of public dollars.

We recognize that California has made real progress modernizing behavioral health care, but that progress is fragile in this moment. And it won't withstand the coverage losses or funding instability that threaten it.

For people experiencing anosognosia and so many more, recovery depends on a system that does not require insight in order to offer care and does not disengage when insight is absent. That's the standard that we should be building towards.

We respectfully urge the legislature to protect Medi Cal behavioral health co coverage, close the symptoms system gaps, strengthen provider capacity, and invest in long term supports for Californians living with the most serious mental illness. Thank you.

Thank you so much. And Thank you, Leandra. Director Navarro, when you're ready. Hello.

Good afternoon, Madam Chair and Members. Thank you so much for the opportunity to present today on this really important topic. One, that my colleagues who've worked with me for the past 35 years in behavioral health in California know,

is something that I've been advocating for more awareness about for at least the last twenty years. I'm currently the director of Santa Barbara County Behavioral Health and have been so for the past four years.

And prior to that, was the director of Tri City Mental Health for seven years. As I stated, I've been a participant as an employee and professional in the California County Behavioral Health System for over 35 years.

I'm here to say that sadly, too many families struggle with the feelings of helplessness as they try to ensure their adult loved ones connect and stay connected to the medication services and supports they need to live their best lives.

Mental health and substance use disorders are chronic relapsing conditions, but recovery and sustained stability is possible.

I have the honor of being able to be a part of that every day. This agenda discusses challenges with fragmented systems, and I wanna speak to that a little bit as well.

It is true that too many individuals cycle between incarceration and a patchwork of community based services, some that focus on the black robe effect such as diversion, assisted outpatient treatment, and care court.

When a person has been deemed too sick to care for their basic needs for food, clothing, shelter, medical care, and personal safety, conservatorship may be used as a last resort.

So often, the very types of programs and services mentioned at first by miss Anderson today are not a part of Medi Cal, whether it's services delivered in carceral or locked settings or the heroic work of public guardians and outreach teams.

In specific reference to the symptom of untreated severe mental illness, Anosognosia, that treatment requires as in the work by doctor Xavier Amador whose book that miss Anderson shared, it requires a relationship building and trust. And it takes a long time.

And it's about not contradicting a person when they say I'm not sick, but it's about seeking to collaborate with them and engage in treatment that encompasses shared decision making, not the top down effect of the medical model, which is you are sick, I'm gonna treat you,

I'm going to put you in this service until you get better and know that you're sick. What that leads to, we know, is that cycle that miss Anderson talked about where folks then cycle in because once that ordered treatment or that forced treatment, if you will,

is discharged and there's a graduation that happens, the person has yet not really had the opportunity to really integrate that this was under their control, that they took the steps to to share in the decision making and the treatment with their loved ones,

that they are the ones that that led to making their lives better, that it wasn't some outside force.

New programs launched by the Newsom administration with strong support from the legislature, expand the tools we have at our disposal to outreach to tools we have at our disposal to outreach to individuals and connect them to services and housing.

CalAIM shifted how we operate, for example, to focus less on diagnosis and more on the need to decide where individuals are met for their behavioral health needs.

This has required a mind shift and an education among our managed care partners to ensure that their networks of providers, which are part of the full spectrum of Medi Cal's or behavioral health services, understand that if a person can be stable and maintain a recovery

with medication and talk therapy, then the managed care plan is the right place for that individual regardless of diagnosis. Another example is California's ninety day jail in reach benefit.

Our local jails are learning more and more about their role in improving the quality of care for individuals health needs, including behavioral health while incarcerated.

Some of those services now will be delivered in that 90 window, and they may even be eligible for federal medical funding.

That's a historic first. And county behavioral health has already been working over the past, year to ensure that those handoffs to whatever level of care, whether it be the county behavioral health system or the managed care system, are hot warm handoffs and as,

maintain continuity care as much as possible. In Santa Barbara County, between the leadership of Sen Cal, our local managed care plan, and our county behavioral health department, I've been working closely with, all of our local partners to share resources and coordinate

around some of the most high risk medical beneficiaries. The right care at the right time is a key priority and underlay underlies CalAIM's no wrong door approach. And with regard to a person experiencing their first symptoms related to the onset of a psychotic disorder

or serious mental illness. That's what the wrong door approach is about. The hope and intention is that individuals will be referred ahead of significant crisis such as incarceration and or hospitalization.

With that as the goal, it is essential that both the county behavioral health and the managed care behavioral health provider partners have the awareness, education, and training to intervene early with these high risk medical beneficiaries.

Moreover, keeping these high risk persons engaged in the right care and stable on medications also requires mind and skill sets most often associated with county behavioral health level services, but increasingly recognized as the entire Medi Cal delivery system's responsibility.

To support these efforts and expansion of these resources, Sen Cal has invested financial resources over the next two years that will allow both Santa Barbara and San Luis Obispo County behavioral health alongside them at Sen Cal behavioral health mild to moderate

partners to better maintain care in that transition. And specifically in Santa Barbara County, funds will be used to educate and train Sen Cal's behavioral health network providers on best practice care for persons experiencing early signs and symptoms of psychotic disorders,

including anosognosia and how to most effectively maintain those in care that are stepping down from the county behavioral health, moderate to severe level of care, specialty care, or have been stabilized while they're incarcerated.

These policy changes, along with the historic behavioral health continuum infrastructure investments in building out new treatment facilities offer hope for our future.

Certainly, anytime a person needs to go beyond what managed care plans provide, the county is here to provide those higher level of services.

But it is a continuum, and we must be able to maintain this built expansion, especially, if the the numbers that you talked about earlier through the Mental Health Services Act, the the number of folks accessing our system,

50% increase in just the last almost two decades. We must maintain the entire continuum of care effectively. County behavioral health directors have more resources and tools than ever before, but it still falls short.

And, unfortunately, the county is still one of the only places that individual can access certain services, like first episode psychosis, peer support specialist services, the mobile crisis benefit, and assertive community treatment.

Because county behavioral health services provided by Medi Cal are most comprehensive specialty services for people with mental health and substance use disorder needs anywhere, offering much more than private insurance or the Medi Cal managed care plans,

the threats posed by federal cuts to Medi Cal under HR 1 will stop that progress in it tracks and leave our communities at far greater risk.

The promise of CalAIM and payment reform has been realized by many counties in the past two years as we are able to then provide the more resources as available to community members who do not qualify for Medi Cal and or whose private insurance companies do not cover them.

So for a time in their most intensive treatment are in our system. But as we proceed, as the numbers of individuals with Medi Cal drop due to HR 1 and our federal funding drops, our system of care as a whole will be dealt a significant blow.

Anything that is not Medi Cal needs to be put will need to be put on the back burner as our, excuse me, as our and we all need to refocus our resources to stay compliant with the Medi Cal and the Behavioral Health Services Act.

It is for these resources that we respectfully urge the legislature to consider that to the extent resources are available means very little in the lives of real people who deal with the anguish of the most excuse me, of not knowing where their loved ones are at or how they

will make it or how they themselves will survive. We urge the legislature to consider the need to shore up the county behavioral health safety net to address the needs of individuals with behavioral health needs as a matter of parity and to acknowledge that without our medical safety net,

families will be thrown further into the abyss. Thank you.

Thank you so much for that testimony, and we'll move to our last panelist. Executive Director Cabrera from the county behavioral health directors association, and if you have about five to seven minutes Max, it would be great. Thank you.

Perfect. Thank you so much, Madam Chair and Members. First, I wanna thank miss Anderson for coming up today and sharing her story, which reflects that of so many loving parents who must endure the feelings of hopelessness at seeing their loved ones suffer when they don't get the right care at the right time.

California's public health, public behavioral health system, in fact, represents so much of what is happening throughout our country's behavioral health systems. It is in no way designed to provide the right care at the right time, unfortunately.

For individuals whose loved ones start to experience the first signs of a significant mental illness like miss Anderson's son, private insurance, whether it is job based or through the individual market, is woefully inadequate today.

We do not have a functioning health insurance market for people with private insurance. No first episode psychosis programs, no peers, no outreach and engagement to make sure individuals are reminded to take their psychotic psychiatric medications.

As a result, preventable disability, education, and job loss, and worst, in the worst cases, homelessness and incarceration are the outcomes. This is a societal feeling that cuts across to reach any and every demographic.

I can think of no system where Californians must rely on Medi Cal and the public safety net entirely because of the complete negligence of private insurance to offer even the bare minimum of services we as consumers pay for every month in employer and

individual insurance premiums and cost sharing. The strain that this failure puts on our safety net cannot be understated.

Today, we are on the eve of a significant behavioral health transformation. Yes. The Behavioral Health Services Act was a signal from the current administration that counties in California must recenter our focus on those most impacted by their behavioral health conditions.

Individuals who are severely impacted by behavioral health needs and experiencing justice involvement and homelessness. This would be great for families like miss Anderson's.

However, so many of the programs and services that do work like specialty courts, diversion, outreach, etcetera, are not medical reimbursable.

With the potential loss of tens of thousands of Californians losing their coverage due to HR 1 along with the focus on those at the deepest end of needs compelled through these behavioral health reforms,

counties are rightfully concerned about what these changes will mean for our state down the line. What happens if we do not shore up both the private insurance and our public insurance safety nets?

We are already threadbare. This phrase to the extent that resources are available, it actually dates back to a change in law in the nineteen sixties, the short Doyle Act, later known as the Bronzema Corcadale Act.

And that is the commitment of the state of California. It says counties have an obligation to provide behavioral health services, but only to the extent that resources are available.

The patchwork of services for those individuals who do not meet the most significant needs as articulated in the BHSA reforms is undergirded by another patchwork at the federal level.

There are many holes and gaps in coverage, whether it is the IMD exclusion in Medicaid or services and supports not covered through Medicare.

Without a stronger Medi Cal managed care and private insurance set of services for individuals upstream of those county behavioral health services, we will only see demand for our services increase just as funding for us plummets.

Counties respectfully urge the legislature to consider investing in shoring up our safety net to respond to HR 1 and the related impacts with the understanding that unfortunately today for individuals with the highest need without a functioning safety net,

there are no good alternatives outside of county behavioral health. We are it. Thank you.

Thank you so much. We're gonna turn to the committee. I have a couple questions, but I'll open it up to my panelist or my committee members. See if anybody else has any questions. Please, Assemblymember Stephanie, please.

Thank you, chair. And I wanna thank the panel for everything you said today and especially to you, Don, for sharing your story of your son. I'm so sorry. I can't imagine. I'm a mother.

I have a son and a daughter, and the lengths you're going to to help him are admirable. And I experienced anosinotia when my father started suffering from Lewy body dementia.

And it's a different form, but I saw it. And in 2017, he would not get seen because he was he was convinced he was not sick. And it took me calling his Vietnam buddy in Colorado to fly out and to make my dad sign papers so he can be seen.

And it was very hard. And he actually just passed away last Wednesday afternoon after a year battle of Lewy body dementia. And so I don't understand it from the perspective of mental illness, but I saw what it did to my dad. And I'm so sorry.

And I've been on the in government for a while now. I was on the board of supervisors in San Francisco for seven and a half years, and before that, I was an aide or chief of staff to two supervisors for nine years.

And we tried desperately with Michaela Aliodapierre to pass Laura's Law, assistant outpatient treatment. And we got pushback every time from the advocates that you mentioned, who should be here today, by the way.

They should be here today because they stand in the way of the lot of the laws that we need, to really address what you were talking about, which is preserving rights over getting people the medication that they need, and I think it's a problem.

We finally got it passed when I when supervisor Mark Farrell took over, and everyone thought it wouldn't work. But assistant outpatient treatment, the black robe effect Showed showed that it was working.

And, I actually have A Bill that I introduced, AB 1676, that's going nowhere this time around. And that would allow for involuntary medication orders with assist in outpatient treatment.

And it's not going anywhere because of the extreme pushback I got before I even got a hearing. And what you described, what you're going through, what you went through with your son, what so many families in California are going through, not just California, everywhere.

When you don't address this crisis is shameful. And the people that continue to get in the way of helping people like your son, who are not present here today in this panel, describing what their solution might be.

I know that they viewed Anastasia with skepticism, and it really burns me up. And so, I'm here to tell you that I am open to doing whatever I can with my colleagues to make sure that we address this.

It is something that has bothered me now for twenty years that we have not had adequate policies in place here in California to address this crisis.

It is borderline criminal, in my opinion, to allow people to cycle in and out of psych wards, jails, and not treat their mental illness. And to do so saying, well, we're preserving their rights. What kind of life do they have?

And they get those people that are arguing that get to go sit home and go to sleep okay, do whatever they are doing with their lives. They don't have to worry about what's going on.

And the chaos that families are going through when they're trying to get help. So I wonder why aren't they here today to be part of this solution? Why are they here to talk about everything that we have faced trying to get people that help that they need and every barrier they have put up?

So I promise you, Dawn, that I will continue to do everything I can as an assembly member to make sure somehow we crack this because it's has to get done, and we have to do everything we can, not just with Medi Cal and everything,

but we have to have laws on the books that actually help people. Thank you.

Thank you Assembly Member. I'm so sorry for your loss.

Yes. Very sorry.

I just had a couple quick questions. I know we talked a little bit about the no wrong door system and sort of the efforts of CalAIM and, just wondering if any of you maybe any if any of you could elaborate a little bit more.

I know there's an issue around not having enough pieces of this medical reimbursable. And so what's working, what's missing, and the no wrong door system that We might need to that we might need to address.

Thank you, Chair, for that question. I wanna be, super clear here in terms of the roles of the various parts of our insurance systems, because I think it's really important context for understanding why the no wrong door policy exists in the first place.

We didn't have non specialty mental health services under Medi Cal before the ACA. The ACA is really the reason why we we introduced that as a new Medi Cal Benefit.

It was handed to the managed care plans based on the philosophy or the idea that the the benefits that the managed care plans have under non specialty talk therapy and medications would be integrated into primary care settings.

Because Medi Cal managed care plans had no real history of delivering these services, They, in order to meet the short timelines, largely contracted out these services to what we call behavioral health organizations like subcontracting, basically.

And the care really wasn't integrated into primary care as originally intended. Right?

And so I wanna be clear because there's there's sort of this assumption that if we had it all sitting under the same plan umbrella that it would make things a lot easier for consumers, and I don't think that's what Californians experience today.

Instead, you have primary care physicians who largely have no idea that these benefits even exist under Medi Cal managed care because they're run by an entirely different organization.

And you have a subset of Medi Cal beneficiaries who may have awareness and then they have to have the wherewithal to be able to navigate how to get to that external organization to get services.

Counties have been around for much longer providing behavioral health services as the safety net to individuals. And one of the things that we knew is that we needed to position ourselves strategically to meet people where they were at.

So we have a history of co locating services at schools with child welfare partners, with our justice partners, etcetera. We're with within homeless services, we're already there.

And some of the work that has been done over the course of the last five, seven years with CalAIM and some of the other reforms under the Newsome administration do hold a lot of promise to improve access for people.

But I would argue that not enough people are being served in nonspecialty mental health services under managed care plans yet, there could be better attention paid to how many people, where are they getting services, and what kinds of services are they getting.

We have had experiences as county behavioral health where, for example, a person with a diagnosis of schizophrenia was completely stable, life on track, they were on a long acting injectable, and we just wanted to step them down to the federally qualified health center

under the managed care plan because they didn't need county behavioral health anymore, but they did need access to those long term long acting injectables. And the health plan said, no way. I don't wanna deal with a person with a schizophrenia diagnosis.

Well, that's not right, and CalAIM should be changing that moving forward, but it really is gonna take a lot of work to ensure that the health care system more broadly is seeing it as their job and welcoming of people with these conditions.

So we have a lot of stigma still within our systems to push aside, and that's why Tony's work within Santa Barbara with San Cal is so important.

There's been so much openness on the part of the managed care plan to learn from county behavioral health so that they can do a better job and step up to the plate.

And because of HR 1 and BHSA happening at the same time, counties are gonna have fewer resources right off the bat. We need both Medi Cal managed care plans and private insurance plans to really step it up.

And I mentioned private insurance plans because most people have their first break during adolescence and young adulthood when they're still on their parents' insurance. And so in order to grab them at that first break, something has to be there for them.

And that's why I'm saying there is literally nothing for people with private insurance.

And so then, they are honestly having to wait until their loved one is so sick, so debilitated by their psychosis and their cycling illness that then they do qualify for Medi Cal, and that is a cost shift that's already baked into our systems.

So we need to put some additional legs in under the stool way upstream of the very sad circumstances that miss Anderson has had to endure.

I would just add very briefly to that. I agree with the comments, and I think that's why this panel is so important. Because what we've been experiencing is a it's a MCP pilot, and now you're hearing how it's working and how it can be better under incredible stress right now for our system.

You know, Michelle mentioned stigma and lack of access. That is true. And even if there wasn't stigma, there would be lack of access, and that would still be problematic. So it's just another layer. We literally have people who are falling through the holes in the safety net.

That's what we're saying. You know, managed care plans don't not knocking them, but they don't necessarily have the capacity and expertise, and sometimes even resources to provide services.

We've heard from so many clients that transfer over and then they're lost and they're navigating a system and they're bouncing back. And that's what I mean when I say those holes in the safety net.

They're literally following through as they go back and forth, and people can't afford to do that. So I think that there's a lot of improvement that has to be made. There's a lot of collaboration and partnership, and the time is very critical at this point.

I just wanted to add that I think, again, I bring my county examples here today because I think they are, the hope and and what is possible.

And, with CalAIM and payment reform and really the focus on the managed care plans taking on their portion of the behavioral health system, if you will, over the past couple of years, we are seeing in we are seeing improvements in the rates that they provide.

I mean, I think early on in the system, the bifurcated system that Michelle talked about at the beginning of the Affordable Care Act, we saw very lower medical rates that managed care plans were paid for the same services that our local community organizations that

contracted with county behavioral health, they would contract with us because our rates were higher. But what we're finally starting to see now in the managed care plan system is their rates are going up.

And I'm really proud to say that since I came to Santa Barbara four years ago, we had, I think, one or two of ours local community based organizations that were contracted with San Cal from mild to moderate.

And I have really been sounding that horn saying you are the experts. You do this work with us. You will be able to maintain folks. There will be a continuity of care that folks will be able to stay with the same provider, but in a lower level of care.

And so now all of my CBOs that contract with me for mental health services are also mild to moderate providers in the SEN Cal system.

It's expanded capacity greatly. And and I think those are some again, that's the promise of CalAIM, but it really has to be intentional and strategic, really kind of pushing the managed care plans to really look at that in a different way.

Under the Mental Health Services Act for twenty plus years, county behavioral health had significant funds, and we were just able to just take that on, and we're providing that level of care.

We don't see that, anymore under Behavioral Health Service Act, and we will be and and being held accountable to be much more clear about whose lane is this client in based on a standardized screening tool.

And so the the the goal is to fortify the networks, and that requires a lot of training.

Again, on the county behavioral health side, we had a lot of benefits. We had the workforce education and training bucket under MHSA for several years that we were able to fund and provide high levels of training.

Many counties were able to bring in doctor Amador's LEAP program professionals and specialists and train our networks on that.

Our managed care plans, we are hoping, and then what we are asking them to do is to do invest in the same for their provider networks with the with the Community Investment Dollars and other things they have available to them.

Thank you. I appreciate that. It's a that's a complex topic. Obviously, if you've been working on it twenty years, and I know, Dawn, you've been working on it since the nineties. I didn't know if you had anything else to Yeah.

I wanna add on this particular.

The LEAP training, we could spend some money and help family members that you already know have their first diagnosed or second diagnosed loved one living with them, help train the family members,

the LEAP training, and go side by side with them so that their loved one's willing to stay home. And that would save cost immensely, and it would create a relationship between the workers and the family member, your loved one, and it could change a lot of things.

That's a big ask, but worth it in the long run.

Thank you. And I appreciate Dawn brought brought this book to my office. It's been over a year, I think, since you dropped the book off, but I've been I've been re yep. Exactly.

But I've been re I have been reading the book and another companion book with it and really wanna say that I I appreciate that and appreciate the education.

We are gonna open it up, seeing no other questions from members of the committee. One more. Assembly member, actually.

Just, to follow-up on the conversation you're just having. So it sounds like there are some conversations happening around getting managed care to do a better job of covering this.

But is there is there somewhere that lives or should live in terms of that kind of collaboration and coordination and and encouragement?

You know, I think it it really takes building awareness and more of this kind of conversation about what the respective lanes are as Tony was talking about because we've been refocused as county behavioral health. We've been given our marching orders. Right?

We we stand in the deep end of the swimming pool. We are, you know, being told refocus. No more spreading the peanut butter around. No more plugging gaps for people with commercial insurance who can't get access.

No more doing prevention programs only under BHSA.

No more propping up the managed care plan systems for their stuff. And so I think it is upon really the legislature as we transition administrations to let the state administration know, DHCS, what your hopes and expectations are for that non specialty benefit as well.

Right? There's been an intense focus on county behavioral health the last several years. A lot of good has come out of that. And I would say that we haven't had enough conversation about the earlier stages of intervention,

whether that's through Medi Cal managed care nonspecialty or, again, I'm just gonna say it one more time, private insurance companies that have nothing for us with job based coverage. Nothing.

They got we got nothing. And so that to me is one societal failure that we can more readily course correct. Access to first episode psychosis should not be limited to people with medical benefit coverage.

Thank you. Seeing no other questions here, we're gonna open to public comment for this issue. If you could state your name, your organization, and your position on this item. Thirty seconds.

Good evening, Madam Chair and Members. My name is Elise Jones. I'm the Director Lake County Behavioral Health Services. We're a small rural county, about 68,000 people.

I want to let this membership know that since 07/01/2025, we have billed a total of 1,400,000 to private insurance plans. Of that amount, we have received only $7,500 in reimbursement. The remaining claims have been denied largely due to provider type restrictions.

Most private insurance plans reimburse only licensed Clinicians, which means all case management services and all mobile crisis services delivered by unlicensed staff are categorically denied.

This results in significant uncompensated work and administrative burden for our department. Thank you.

Thank you. Seeing no other, public comment for this item, we'll say thank you to our panelists. We appreciate you, coming. Of course, you're welcome to stay for the other issues, but we understand you have places to go.

So we're gonna move on to issue number two, which is children and youth behavioral health initiative, an update on the fee schedule and behavioral health services online apps and support platforms.

And I have a little bit of, tough feedback, I guess, I'll say for for some folks on this panel that this subcommittee has administration provide information in writing on both of these items well in advance of today's hearing.

We've actually been talking about it for a couple months now, wondering when we're gonna get this information that's been requested going back into March. Information was not provided in time for this agenda to be published.

And in some cases, we only received information hours after the agenda became publicly available, which has been very frustrating for members of the subcommittee as well as for staff.

And I'll just just to clarify for those watching and for our panelists, the kinds of things that this subcommittee has been asking for are really basic information around these mental health apps.

I know it's been interest of the Assembly Member here as well.

Things like contract costs, copies of existing existing presentations, implementation data around these behavioral health apps, things that we would have expected the administration would have readily available and be able to send to this subcommittees so that we could

digest ahead of this hearing. So in my opinion, these are not unusual asks or burdensome ask or even difficult ask.

It's sort of the minimum that we would expect for the administration to have sent to us or shared with us as a coequal branch of government. Understanding it's May revision and we're all very busy and have have a lot going on. There's a lot of demands.

But these are expensive programs. When we talk about the online behavioral health platforms, there's about $640,000,000 of general fund that's gone to these behavioral health online apps, and it's been exceedingly difficult to find out who's using them.

Are they effective? How do we judge their effectiveness? Has anybody benefited? Do we even know anybody out there in the world that's using these behavioral apps?

The proposal, I think, is to put another 100,000,000 just over a 100,000,000 into these behavioral health apps. In my opinion, we're closing in on a billion dollars potentially for these behavioral health apps.

If we get to 740,000,000, and I think about the other things that have been proposed to be funded or not be funded in this year's budget and the devastating effects of that.

And so 640,000,000 could go a long way if it's used for something effective. A 100,000,000 this year could go a very long way. I can think of many ways to spend a $100,000,000 that would actually touch people's lives and give them health care, health care that they need.

So I do think it's the responsibility that we all hold jointly to share with the public what kind of investment this is, to monitor this investment, but most importantly, to be transparent about this investment and about this investment and about what's being asked of the legislature

with this proposed budget. So we have a number of outstanding questions, particularly around the behavioral health apps that I'm sure you'll hear from members.

But I also really would like a firm and a firm and very specific commitment that we're gonna get the data that's been asked for and that you we really will begin to see, how we're judging these, who's using them, how are they effective,

what does effectiveness mean when this amount of money is being asked for. So we'll dig into these issues and then go to public comment after talk after member questions.

But I will turn it over to our panelists to to introduce yourself and to present on this issue.

Thank you so much, Chair Addis, and to the Members of the committee for inviting us here today. And and to your point noted, I believe all of the requested information has been now, delivered. So apologies for the delay.

Also just wanna start, by saying thank you for your public service on this first day of public serve service recognition week. Appreciate all that you're doing for Californians. And again, thank you for having us. My name is Autumn Boylan.

I'm a Deputy Director at the California Department of Health Care Services. I'm really pleased to share actually that we have some really exciting updates to share with you about the children and youth behavioral health initiative and particularly around the virtual

services platforms programs as well as the CYBHI fee schedule program. As we heard from some of our panelists earlier today, including Director Navarro and Michelle Cabrera, the continuum of care throughout the continuum of care is critically important to make

sure that we are able to serve people throughout throughout the stages of of mental health and mental illness. Prevention and early intervention are particularly critical to preventing crises, hospitalizations, and lifetime mental illness.

As you may know, 50% of all lifetime mental illnesses start to show signs by the age of 14 and 75% of all lifetime mental illnesses start to show signs by the age of 24.

Through the children and youth behavioral health initiative, the Department of Health Care Services has administered almost 20 different strategies to address these needs for children, youth, and families throughout California.

Including leading investments on school based behavioral health, evidence based in community defined evidence practices, implementation of new medical benefits, for dyadic services and the certified wellness coach benefit,

as well as the digital strategies designed to improve access to behavioral health services and sports for all children, youth, and families in California regardless of insurance and regardless of immigration status.

Today, I will highlight some of these work streams as you noted, and get into some of those details. So first, I'll speak to the virtual services platforms, which include a portfolio of digital behavioral health interventions and programs, but also includes, as you know, BrightLife Kids in Soluna.

These are not the only programs that are part of the virtual services platforms portfolio, but we'll focus our attention, on those for today. California is, this is the first in the nation's strategy to provide free preventative culturally responsive mental health support for all

California children, children, youth, family, and caregivers, as I said, regardless of insurance coverage. The platforms were designed to address long standing challenges for families, including long wait times, cost, transportation barriers, limited provider availability,

stigma, and scheduling constraints.Two years in, the data show that they are delivering on that promise. Last month, just a couple of weeks ago, DHCS released its 2025 impact report highlighting significant growth in utilization, testimonials from users,

and research findings significant find research finding significant improvements in clinical outcomes for users of Brightlife Kids in Soluna.

Since launch in January 2024, Soluna and Brightlife Kids have generated over 530,000 registrations for for children and youth specifically.

So that's children and youth associated with accounts for Brightlife Kids in Soluna, surpassing more than half a million total registrations statewide in January 2026, and those numbers continue to grow.

We've seen a significant year over year growth across both platforms, in a 156% increase from 2025 to the 2026. Families and youth have completed over a 112,000 telehealth coaching sessions as of January 2026 with again significant year over year growth in utilization.

A primary focus of CYBHI's digital strategy is reaching children, youth, and families who have historically not had access to care both by expanding services and reducing barriers.

More than 50% of users of both platforms have never previously accessed mental health services based on their own reports. 50% of Saluna users also report that without the platform, they would not have been able to access care at all, citing financial, logistical, and personal barriers.

The platforms dramatically reduce wait times for services. For Brightlife Kids families, the wait is an average of only 1.4 days for a telehealth appointment with a behavioral health specialist, and Saluna has an average of a four minute wait for drop in

coaching services seven days a week from 10AM to 10PM. While 99% of scheduled sessions with the youth's coach coach of choice is scheduled within three days.

This level of immediacy allows early intervention well before needs escalate into a crisis and need to take up higher level of services in the continuum.

Brightlife Kids and Soluna help to address common issues facing children, youth, and young adults. Issues that without intervention and support, pose a risk of escalating into crises or lifetime behavioral health conditions as I noted above.

The most common reasons that families turn to BrightLife Kids include stress, worries, and anxiety, attention in ADHD, social emotional skills, self esteem, sadness, and depression.

And the most common reason that youth turn to Soluna are relationship issues, including relationships with parents, peers, and romantic partners, anxiety, low mood, and stress.

We also know that equity is central to the approach with the children in youth behavioral health initiative, and families in lower resource communities, rural communities are accessing care through Brightlife Kids and Soluna.

There's representation across all 58 counties in California with users in every county. 52% of Saluna users and 73% of BrightLife Kids users identify as black, indigenous, or people of color, and 55% of all users live in areas identified as under resourced by the Healthy Places Index.

Outcomes across both platforms show meaningful improvements and well-being for children, youth, and caregivers, and users are reporting satisfaction with services as well as goal attainment.

For Brightlife Kids users, 89% of children who engaged in coaching showed improvement in mental health symptoms, and 83% of caregivers reported reduced strain after using Brightlife kids coaching services.

Additionally, for Saluna, 85% of users reported having at least one of their needs met in a single session, and 98% reported feeling heard and respected by the saloon coaches. 90% say they received the support that they wanted and needed.

Further, Northwestern's university lab for university's lab for scalable mental health an internationally recognized research group and premier experts in digital behavioral health interventions for youth, conducted an external evaluation of Soluna to assess mental health and well-being outcomes over time.

The research is currently under peer review with the journal Internet Interventions, a multidisciplinary and interdisciplinary peer reviewed journal focused on areas of studies such as clinical psychology.

The researchers at Northwestern found that Soluna participants experienced statistically significant reductions in overall distress after one month using Soluna with improvement sustained at three months, which is a pretty incredible finding.

A core part of the design for Brightlife Kids in Soluna has been integrating care navigation services so that these programs also function as a digital front door to a broader behavioral health delivery system.

For many children, youth, and families, they don't know where to turn and Brightlife Kids in Soluna offer them a front door solution that will get them connected to community gay community based care and supports.

Care navigation teams ensure that users are connected to appropriate in person school based, community based, or crisis services when needed.

So if a user meets with a coach, for example, and it is apparent that they would benefit from higher acuity mental health services, the teams are designed to complete closed loop referrals to support these users and connecting them to the right level of care.

Together, these platforms have completed over 5,000 referrals to higher acuity mental health services and social services across California.

In just the two years since since launch, BrightLife Kids in Soluna have significantly increased the number of children, youth, and families receiving behavioral health services, built strong community partnerships, and expanded the behavioral health ecosystem of care.

Another peer reviewed study about school and community so stakeholder perceptions of Soluna conducted completely independently of DHCS and Couth. We didn't even know about it until the research was published.

Surveyed 77 stakeholders in California from February to April 2025. 71.4 of stakeholders, including school personnel, agreed that Salina positively contributed to youth well-being, and 89.6 felt comfortable referring youth to it indicating good acceptability.

They noted free access, availability during nontraditional hours, and ease of use as the most valuable features for youth.

At the local level in Monterey County, for example, nearly 6,000 children and youth are signed up to use BrightLife Kids in Soluna, and 963 telehealth coaching sessions have been delivered through 01/31/2026.

Brightlife Kids and Soluna have three affiliate network providers in Monterey County and provide closely peripherals and warm handoffs to users that need that higher level of care in that community.

They have 48 community partners across Monterey County, including the Monterey County Office of Education, Monterey County probation department, WIC Monterey County, Go Kids, and Zocalo Health.

In Los Angeles County, more than a 127,000 children and youth are signed up to use BrightLife Kids and Saluna, and over 21,000 telehealth coaching services have been delivered in that same time period.

They have 24 affiliate network providers for the close loop referrals and warm handoffs to community providers in Los Angeles County for members who need a higher level of care, and they have 669 community partners across LA County, including 211 LA,

Los Angeles Unified School District, LA County Department of Mental Health, YMCLA, YMCA LA, and Tarzana treatment centers.

In addition, last fall, the LA County Board of Supervisors passed a board resolution requiring all youth serving county agencies to develop a plan to make Soluna readily available to youth, teens, and young adults throughout each agency's programs.

San Diego County made a similar resolution for BrightLife kids. I have more data and information about other counties, but for the sake of time, I will move on, but happy to answer additional questions.

Soluna is working with partners across all 58 counties, including youth, families, and educators to obtain input, build awareness, and establish partnerships in key sectors.

They have 66 youth ambassadors promoting Soluna with youth in their communities, normalizing conversations about mental health, and connecting peers to support. They these youth also advise on product enhancements and help co-create in app content.

They've also launched Soluna family voices, which includes 45 parents and caregivers to help shape Soluna by sharing insights on what families need most. And the Soluna educator ambassador program includes 391 school staff and educators throughout California.

Just a couple of weeks ago in April, the Steinberg Institute convened cross sector leaders to create strategies that support implementation of Salunas safely, equitably, and effectively across California.

And in February 2026, a report about CYBHI investments, children now highlighted BrightLife Kids in Soluna as one of the CYBHI investments focused on improving access to services, which address behavioral health needs in the early stages of onset and

recommended that the state should continue to expand access to upstream preventative resources and services by continuing to scale best practices identified during efforts today.

That same scaling and access to upstream services that we heard from the panel earlier today, although I admit they were not specifically talking about Brightlife kids in school.

Both the California Department of Education and the California Surgeon General have endorsed Brightlife Kids in Soluna, and both Apps have high ratings from users in the app stores.

The governor's budget proposes to continue funding for Brightlife Kids in Soluna as you noted, as well as the CalMAP program, which is a part of that same portfolio.

For Brightlife Kids in Soluna, the cost per active user with the contracts just for Brightlife Kids in Soluna is only $583, and that number will continue to shrink as the total utilization goes up over time.

The data I shared with you today demonstrate an overwhelming return on the historic first in the nation investment made by the legislature and the administration, and other states are starting to take notice of what California is doing.

This is truly a momentous investment to be proud of, and we thank you on behalf of children, youth, and families in California who are benefiting from these amazing programs. I do also have an update about the CYBHI fee schedule program if you'd like me to continue.

Let's do the fee schedule. We were gonna separate them, but just due to time, let's go over the fee schedule, and then I know there's questions from members. Sounds good.

So next, I will highlight the significant progress we've made implementing the CYBHI fee schedule program.

As the department previously shared, the CYBHI fee schedule program is a first of its kind effort to make it easier for students and families to get outpatient mental health and substance use disorders support when, where, and how they need it.

This is a multi payer effort that includes private insurance, commercial health plans that are regulated under the Knox Keene health care services plan by the Department of Managed Health Care and disability insurers that are regulated by the California Department of Insurance

as well as the medical delivery system. The intent is to create a sustainable infrastructure for reimbursement for local educational agencies, public institutions of higher education so that they can receive funding for services rendered at a school or a schooling site

for children and youth who are under the age of 26, enrolled in a public t k through 12 school, or an institution of higher education, meaning our public colleges and universities, and covered by our health insurance plans obligated under the statute.

DHCS has continued to partner with education partners, managed care plans, state partners to shape this program with notable successes in implementation and systems and reimbursement benefits for school partners.

Although the program initially launched with the first learning collaborative cohort in January 2024, it has only been sixteen months since the very first fee schedule claims were submitted and reimbursed.

The first claims, were submitted in December 2024 or November 2024 and paid in December 2024. Since then, the number of LEAs, colleges, universities, and schooling to providers that are submitting claims for reimbursement,

the number of students benefiting from reimbursable services and the number of schools participating in the program have all grown exponentially.

We just provided data that was, as of 04/20/2026, but I did bring data that is as of today. So I will share that with you and happy to update in writing as well.

More than 500 LEAs, county offices of education, charter schools, colleges, and universities, and school linked community providers that are part of a school delivery network of care, are signed up to participate in the CYBHI fee schedule program as a lead or

independent agency. An additional 505 LEAs and community colleges are indirectly participating in a reimbursement in the reimbursement program as part of a consortium led by another LEA or the county office of education or a community college district.

We established the the consortium model to allow for small and rural LEAs and community colleges to be able to join together under the county office of education or another LEA with more administrative capability to be able to still benefit from participating in the CYBHI

fee schedule program. In all, 72% of all school districts statewide have signed up for the CYBHI fee schedule program. And DHCS is working with the California Community Colleges Chancellor's Office to help support the California Community Colleges implementation efforts.

The goal is for all of the public TK through 12 schools and institutions of higher education to participate in the program and provide them a permanent source of funding for out for school based behavioral health services.

The amount reimbursed to LEAs, colleges and universities, as well as school affiliated providers as of today is $9,600,000.

This is a significant increase from July 1, where the amount was under $300,000, and we've seen, a a significant increase even just since January 1 where we increasingly are seeing a large volume of claims being submitted and reimbursed from week to week as we get reports

from our third party administrator, Carol on behavioral health. The total allowed amount billed to date is just over $10,000,000, and, 41,556 students are represented in claims that have been submitted for reimbursement.

This, we know, is not all of the students in the state of California that are getting school based behavioral health services in local educational agencies throughout the state, and so we expect that this number will grow exponentially as more and more local educational

agencies scale these programs at the local level. The number of LEAs and colleges and universities that have submitted claims for reimbursement to date is 181 LEAs.

And if you think about the fact that some of the school districts are phasing in on every six months on a cohort model, We're actually for the first four cohorts, which began by July 2025, 64% of the LEAs that began by July 2025 are submitting claims.

And of cohort five, which just launched in January, we have 12 LEAs that have already advanced to the claims submission stage. So below just a is a sorry. A quick snapshot of reimbursement in counties represented by members of this committee.

Monterey County has received $204,000 in reimbursement primarily from Monterey Peninsula Unified School District. Santa Cruz County, almost a $100,000 in reimbursement. San Luis Obispo County, $30,000 in reimbursement.

Placer County is just under $20,000 of reimbursement. And I didn't I did not bring the Los Angeles numbers apparently, but there are many school districts in Los Angeles County that are also participating.

Before the program initially launched in 2024, we started to collaborate closely with county offices of education, LEAs, statewide education stakeholders, and labor groups, the Department of Managed Health Care, the Department of Education, and the State Board of Education

to obtain feedback and input on the program. And further, in accordance with SB 144 passed last year or earlier this fiscal year, DHCS launched the biannual fee schedule working group in March 2026 and brought together 300 key stakeholders to discuss implementation

progress and offer a forum for stakeholders to share feedback and identify opportunities for continued improvements. To address concerns from LEAs and to mitigate the need to collect student health insurance information, in November, Caroline Behavioral Health,

the state's third party administrator, launched a new health plan member matching tool through its claim portal for the CYBHI fee schedule program participants.

Today, 8 health plans with an additional 12 onboarding capabilities in the next 3 to 4 months are, have their student enrollment data loaded into that platform so that school districts throughout the state can do a member lookup to identify the students' health insurance information.

In April 2026, DHCS launched the new medical matching data process, to allow LEAs and colleges and universities to submit student data that will be then matched with the medical eligibility database to identify assigned medical MCP for that member.

Six LEAs have already taken advantage of the new medical matching procedures, resulting in 23,000, records match records being returned to LEAs.

In the fall, DHCS launched a statewide media campaign in English and Spanish to raise awareness amongst parents, caregivers, and families about the fee schedule program, including why school districts might ask for health insurance information,

how the information will be kept secure, and how their child's data will be used. And those resources are available on the DHCS CYBHI fee schedule website, in our resource library among other helpful tools.

In July 2025, the California Health and Human Services Agency with input from DHCS and a work group of cross sector experts published its HIPAA FERPA toolkit to help LEAs and colleges and universities better understand the intersections between HIPAA and FERPA

as well as to understand the federal requirements, especially under FERPA for obtaining consent for data sharing.

Those various surveys and stakeholder forums or through various stake stakeholder forums, DHCS has heard from county offices of education, local educational agencies, and others that would be helpful to it, develop additional guidance and tools for local implementation.

In response, DHCS and Caroline Behavioral Health have worked closely with the California Association of School Counselors and the California School Nurses Organization to develop illustrative billing guides that map real life everyday scenarios for school counselors

and school nurses, to CYBHI billable service services and codes. We've also worked closely with HCAI, the Department of Health Care Access and Information, and the School Counselors Association to help school counselors better understand the role of certified wellness

coaches and supporting school counselors, including scenarios for billing for these support services. Additional tool kits for school psychologists, school social workers, and others are on the way.

DHCS has also shared additional information about program monitoring and oversight, which we have heard from COEs and LEAs is an area of concern that is preventing many from scaling their programs.

So we've started to issue additional guidance including about program integrity measures that will be implemented by Carillon and DHCS, and to dispel concerns from LEAs about the robust auditing processes of of the LEA bot program.

It is not the same kind of monitoring and oversight mechanism for the CYBHI fee schedule program. In the 2025-26 school year, in addition to the significant growth in claims, volumes, and reimbursements described today,

DHCS and Carolina Behavioral Health have also seen significant progress in LEAs and, colleges and universities advancing rapidly through onboarding processes and getting to the claim submission stage of onboarding more quickly.

A majority of participating or, lead or independent LEAs have completed the administrative onboarding steps required for submitting claims.

And Caroline Behavioral Health has conducted over 1,800 individual one on one technical assistance sessions with 282 local educational agencies and colleges and universities.

They've also released a comprehensive onboarding guide, new training materials, and just started launching in response to LEA feedback, a brand new, program representative, support unit within their, within their team to support small and rural school districts and community colleges.

In addition, and nearly finally, see county offices of education and LEAs report numerous reasons for slower than expected uptake in claims volume, including needing to complete procurement processes for billing vendors, rolling out the CYBHI fee schedule

program in a thoughtful and strategic manner across provider types with many LEAs starting with either licensed personnel or people personnel services, but not typically both at the same time, providing training at the local level about the program and documentation requirements.

They're starting small and scaling up. Ultimately, these local implementation strategies will lead to a solid foundation for future success, and we've seen significant recent growth as a result.

While implementing this new infrastructure has been a challenge, and again, California is the only state in the nation working to streamline school based services reimbursement in this way, the mandate is clear and DHCS is firmly committed to establishing a sustainable school

based provider network so that eligible children and youth can access behavioral services that they need in schools.

And the governor's budget does include a request to cover the continued cost of administering the program, and we look forward to your questions.

Thank you.

Thank you. Anything from LAO or DOF?

Thank you, Madam Chairman Min Li with LAO. We're aware of the information that was just shared by the the department. We will review it as well as the updates shared here today, and be available to answer any questions.

Nothing else? Okay. I think I'm gonna start with the fee schedule and I know there's questions on platforms as well. Could you repeat the numbers to I know you said my county. So 204,000 to Monterey County, 30,000 to San Luis Obispo County, and how much to Santa Cruz County?

Yeah. Sorry. Just going back to those.

That's okay. And then you said through the Medi Cal matching program, 23,000 students have been matched statewide.

Yes. Yes. So Monterey County has and and primarily Monterey Peninsula Unified School District has received $204,202 in reimbursement. The Monterey County Office of Education has also recently started to submit claims, and they received their first reimbursement in April 2026.

The claims were just one claim was submitted in at the February, and it's been paid. For San Luis Obispo, it's, just over $30,000 in reimbursement. For Santa Cruz, 98,925. I said almost a 100,000 in my testimony.

Placer County is just under $20,000 in reimbursement. Alameda County is $27,893 in reimbursement. And, unfortunately, I did not bring the the numbers for Los Angeles County.

And what's the cost of administrating the program? I'm sorry? The cost of administering the program.

The it's the what we is in the budget from the 2025 budget act is $69,300,000.

So I just I just wanna I just wanna make sure I understand this. The program costs something like $70,000,000 in 2526. Just from my three counties, they've gotten back maybe $330,000?

That's correct. But as I said, there are many reasons that school districts are rolling it out carefully and slowly. I was at the California School Based Health Alliance Conference at the beginning of last week, and we did a site visit in Kern County in the latter part of last week where we're visiting

school district sites, going around tours of the county and looking at different different setups and how they're kind of managing the fee schedule implementation.

And really what we've heard as we're in communities and talking with our school district partners is that they are being thoughtful about how they're rolling out the program.

But we've seen, over $500,000 in reimbursement on almost on a weekly basis since January, and it's such a significant growth that I do believe that, like, we're still really in the infancy of this program.

I think folks are rolling it out. They're getting all of their procurements and their billing vendors in place. They're doing training, and they're rolling things out, and we're starting to see that momentum and that growth.

Which is what we were told last year when we covered this issue.

Well, that was all.

I think it was the exact same talking points, and I don't mean to be critical of you. I'm just Yeah. It was pretty much the exact same same docking points last year was that we're seeing a lot of growth. People really wanna do it. It's you know, we're starting to get there.

And yet, a year later, I'm hearing my counties at least have maybe gotten $330,000, not even $330,000 if I'm looking at this correctly, barely over that.

So I'm just saying what I'm hearing from school districts and what I'm seeing across California and what we're hearing from the field is not that the field is, being slow and intentional and and and judicious. I'm sure they are, but I don't think that's what the problem is.

Particularly for a program that costs $70,000,000 to administer, I would think we'd be getting a better ROI on this. And the legislature puts in $70,000,000 to administer a program.

I think anybody would expect I'm just astounded that one of my counties, the school districts in one of my counties has only gotten $30,000.

So the point being, I think when the legislature says yes to $70,000,000 that each member is thinking that there's gonna be an ROI for their school children that's gonna be I don't even I don't know if I can do the math on 30,000 compared to 70,000,000. Yeah. But it's infinitesimal.

And so I think members have expected this rollout in this program to be moving quickly because we believe in getting mental health services to children.

And so it's disappointing that a year later, we we had this very same conversation last year. I was told the very same thing. Members of our committee asked questions. We're all told it's going great. Everybody's trying.

And so I think we would have expected this year to see more movement, particularly since you've already got a third party administrator. So I'm not sure what this administrator is doing. If we're only getting $30,000 back to a county like San Luis Obispo. So that's one piece.

I'm carrying a bill to to try to get more help to the school districts really through the county offices of education to be able to hit a couple things. One would be capacity building and the other would be the 0 to 5 age group that seems to be also missing when we've looked at the data.

Most of this money when it's getting reimbursed is is going to older children even though the data says we really need early intervention when it comes to behavioral health.

So I just I don't I have less of a question and more of a comment that I would have expected to hear a different level of growth in a year given the amount of money that's being put into this particular program. And so I'll just say I'm just I'm frustrated.

I'm frustrated by the low results, and I'm wondering, I guess, what else the administration could do.

It sounds like you're putting in You've got a lot of different things going, but it sounds like something like, the you're missing the mark on how to get this money out the door to to children, basically, to service children. And so I would have hoped to see and hear something different.

I don't know if anybody else has questions on this. Assembly Member, please.

May I respond?

Sure. Sure.

Okay. Thank you. I'll can wait for your questions. But so just, I guess, a couple of things in response to your comments if that if you, respectfully. The overall only 14% of claims across LEAs have been denied.

And so, really, if you look at there are some school districts that have higher denial rates where Carolina Behavioral Health is working with them through the technical assistance sessions to be able to help them make corrections for common errors that are made in the process.

Most of the claims, like 70% of claims that are denied are for a correctable reason, and so Carolina Behavioral Health works with the school districts to make those corrections and resubmit.

But across all claims, only 14% of unique claims have been denied. And so part of the issue that you're raising is really an issue of volume of claims that are submitted for payment, which is obviously not in the control of the administration or of Carolina Behavioral health.

So we're trying to help the school districts increase their scale at the local level in what they're submitting for reimbursement. It's not a problem of claims being submitted and not paid. It's a problem of claims not yet being submitted for payment.

LEAs do have 365 from the date of service to submit claims, So there's also potentially a significant lag in the claims volume, and that was a change that was made from the legislature as part of SB 144 that we implemented immediately.

So we don't even have all of the claims that have been for services that have been delivered in this school year that have yet been submitted to Carolina for for reimbursement. So that's one thing I'll say.

We did disseminate $400,000,000 as you know to county offices of education as part of the school league partnership and capacity grants to support implementation of the CYBHI fee schedule program.

And county offices then gave grants to local educational agencies in their counties to be able to support implementation of these efforts. Most of those dollars are still unspent and are there's a spending plan in each LEA and county.

The funds have been disseminated, by the way, but they're held locally as they're working through administration and implementation of the program at the local level.

And as part of that schooling partnership and capacity grants effort, 70% of the, dollars had to be used for fee schedule implementation support, but we've also contracted with the Sacramento County Office of Education and the Santa Clara County Office of Education to support technical assistance efforts.

They have subcontracted with five regional leads throughout the state. Just three weeks ago, I was up in Chico, California with the Far North counties and their regional collaborative providing technical assistance and support to those counties, offices of education, and their partners.

And the Sacramento County office of education and Santa Clara County office of education regularly hold weekly communities of practice where they are engaging with, their colleagues and peers and identifying best practices for fee schedule implementation, and we support, of course, all of those efforts.

And then lastly, I'll just say we are seeing claims for services provided to students throughout the, lifespan of the Children Youth Bureau Health Initiative, so 02/25. About 9% of all of the claims are for children, ages zero to five.

So we do know that county offices of education and local educational agencies that are operating a preschool program or a TK program, or where there is a preschool program on campus, we are supporting those programs as well through the CYBHI fee schedule program. So you're right.

It is a majority of school age children, but this is a school based reimbursement program, and we are seeing claims for younger children in the data, for the claims that have been submitted to date so far.

Great. Thank you. Assemblymember Schiavo.

Thank you for the update. I wish we had gotten data more than thirty minutes before the hearing.

So it's a little hard to digest it. We're trying to add some numbers and do some things right here on the spot. So I appreciate I guess, let's start with the fee schedule piece. I appreciate the comment around doing some education and education campaign.

Fair.

I checked in knowing that this issue was coming up today. I checked in with a number of my school districts. And that was one of the things I heard is that people are hesitant to give their health insurance information and feel a little uncomfortable with that.

And so I feel like the education piece is a really important and critical piece of that to make sure that people feel more comfortable and safe doing it so that they the schools can get reimbursed.

Do you know what the total reimbursement is to the point that the Chair was making around the 70,000,000 and how much her counties have gotten back? Do you know what the total is? I see this very long spreadsheet with lots of counties and schools.

The total reimbursement, as of so I know, as of today, it is we get a report every week, so that's why I updated it for today's hearing. The total reimbursement today is $9,600,000. I believe in what we provided, it was $8,200,000.

So even in just two weeks from the prior report to today, we've seen an increase in over $1,000,000 in reimbursement.

Okay. And so that's the total length of the program. Right?

Yeah. That's cumulative amount. Yes.

And do you know as the Chair mentioned, we've had a hearing on this before, discussed this before, especially as it was kind of struggling to come together, and schools were having a really hard time, you know, doing the reimbursement. Do you know where we are this year compared to last year?

Yes. Actually, so for the amount reimbursed from July 1 to today, even at the $8,200,000, it's a 2600% increase in reimbursements. We were just at 300 under $300,000 on July 1. We're at $9,600,000 today, and there's more than 159% increase just since 01/01/2026.

So, again, we're seeing very rapid change in 2026 in the amounts that are being reimbursed.

In July 2025, there were only 30 LEAs that had submitted a claim for reimbursement. Today, we are at 181 LEAs that have submitted a claim for reimbursement and a 177 that have received reimbursement under the program. Okay.

And and so is this I know where there were different cohorts. Yes. And are there it goes up to cohort four. Is there cohort 5 or 6 or 7 or how many cohorts do we have? Because I see, you know, some counties are not on this list.

That's correct. There are six total cohorts that have been announced to date. The first cohort started in January 2024, but that was the learning cohort. So we were kinda spending that time code developing and designing the program. The first claims were submitted in November 2024.

Cohorts two and three started January 2025. Cohort four started in July 2025. Cohort five just launched in January, and cohort six doesn't start until July. So every six months, there's a new cohort. And as I said in my testimony, we have 72% of school districts.

Not LA includes county offices of education, school districts, charter schools. We have 72% of school districts and 50 out of the 58 county offices of education are already a part of a cohort.

Okay. And and at the end of the six cohorts, it's gonna be a 100% of the school districts or They they have to optionally choose to participate?

They do have to optionally choose to participate. There's no mandate on the school districts to participate, but but no. It won't be a 100%. That number of 72% and 50 out of 58 is through all 6 cohorts that have been announced. So there will be a 7 cohort until we have all of them.

Okay. Okay. Okay. So there will be more than six cohorts eventually. Okay. Well, I know I mean, I had serious concerns about how this program was rolling out last year. I'm glad that it's improving.

I mean, I see the denial rate is kinda all over the place. So I hear you saying 14%, but some have a denial rate of 80%, 55%, 99%, and 37%. And so it seems like there's a learning curve here.

Are so on any denials, the the third party is following up with the school district? Correct. Okay. Okay. I think that's all of my questions for that.

Yes. Did you

Any other questions?

Oh, I have more questions. Sorry.

On the fee schedule?

That not on the fee schedule.

Maybe let's do fee schedule and then Sure. Okay. Any questions on the fee schedules?

Okay. Let's move on then to the BH behavioral health platforms. And then after member questions finish, we'll take public comment on both parts of this item.

Yeah. On the online service apps, I really got very spotty responses from my school districts on these. I spoke with school Board Members. We reached out to superintendents offices.

I talked directly to some school social workers, and I almost none of the school Board Members I talked to knew about this at all. Soluna or BrightLife Kids. And both in my district and here in Sacramento since this is where my kid goes to school.

So the do you I saw the very shiny, fancy presentation with the data on it, but and there's a whole lot of little boxes with numbers. Is there do you have numbers on? I heard you saying how many people signed up.

But do we know, like, what percentage of people are using it multiple times regularly? Like, what is the data on usage? Sure.

Yeah. So for Brightlife Kids, for just in 2026 is the information that I have available. 26.5% of active users are using coaching and life care. And for Soluna from that same quarter, for example, coaching is the most repeatedly used service with 20% of users requesting sessions of all

Soluna users are getting coaching, and 37% are coming back for additional coaching sessions. Part of the good thing about the research with Northwestern University is that they are also the premier experts in single session interventions,

and that's part of the findings from the peer reviewed from the the study that they submitted for peer review is that even with regardless of the number of times that users are using Soluna, they're seeing sustained improvements in terms of overall distress.

So even one use, for example, is showing those outcomes, and we are seeing people coming back. So 530,000 people have signed up or created new accounts or kids actually, not just people because parents and caregivers are also associated with BrightLife Kids,

but over 530,000 children and youth are associated with those accounts. And in terms of active use, about 472,000 of those are active users of the program.

What qualifies as active?

Regular interaction with the different tools. So either coaching, the peer forums, using resources, like some of the, some of the wellness tools that are a part of both Brightlife Kids and Soluna, using articles, watching videos, things like that.

So actively engaging in the content, the tools, the resources, the forums, or the coaching, Not just downloading, making an account, and walking away.

Right. Right. Right. And how often are they engaging with it?

I don't have data on that, but we can circle back.

Okay. That would be great because it could be like, I appreciate that it's not just signing up and walking away. But is it signing up and checking it out and then walking away? Or is it signing up having one coaching session and then walking away? This sounds like it's still unclear.

So my concern and to the point the Chair made earlier is just how much cum cumulatively we have invested in this. And I have a few concerns. One is that this is an avenue to get support, but we're funding and creating a lot of avenues to get support.

And having school social workers on schools has been a huge improvement.

And one some of the feedback that I got from one of my districts was that one school district said the school social workers are are overwhelmed in terms of their caseload, and certainly, they would love more money for that versus an app.

You know, school social worker I spoke to directly said that they had referred a few people to it. They were unclear on whether or not it was helpful or not and felt like students were generally kind of starting to reject tech in some way and preferring face to face.

And I think, you know, especially as we're in the larger conversation, you know, LAUSD just voted to get kids off of screens and reduce significantly reduce screen time in schools. You know?

And this, I'm sure, is not the same kind of screen time.

But but I think it like, everything that we're seeing in mental health, I don't know. It just seems so counterintuitive. And while I know that it can we need to have lifelines to meet people where they're at and particularly when you're in crisis,

it doesn't always happen between 08:30 and 02:30 when you're in school. Right? But, you know, everything that we're seeing around mental health is talking about the need for connection, face to face connection.

And so I just feel like this moves us away from that. It's such a huge amount of money. And at a time when we are having such a tight budget and I wish we had started smaller and been able to have more progress happen than just throw a ton of money at it and get I think right now, it's

like one percent of students are on it or something like that. Is that right? Something like that. And when we could be making investments in more school social workers and things that are those face to face connections that have eyes on kids. Right?

They are the ones who can go out at lunchtime or recess and watch kids interacting and interacting and seeing how they're doing. They can go call them out of class and check-in with them if they don't seem that like they're doing well.

And I feel like we need to be funding more of that and less of apps is how I'm feeling about this right now.

So I hope that we can figure out a balance to that because I just I'm glad that we finally have some data. I'm gonna go back and and look at it more because, obviously, I haven't had much time to look at it at all during this hearing.

But it's when we have to prioritize limited dollars the in person social worker is going to win every time for me.

Thank you. May I respond?

If you could briefly.

I will. Yeah. Thank you.

Very briefly.

I do understand the perspective. I'd like to reassure you a little that, that these programs were designed with that continuum of care and making sure people are getting connected to community based care and school based support in addition to online support.

The reality is that kids have technology in their phones. Right? And these these are not just, programs.

They're they are not social media programs. There are peer forums that are moderated where they can post content only when it's been reviewed by a behavioral health professional for safety, for the community.

They cannot message each other, so they're not engaging in that type of activity, but they are able to get reassurance from their peers. They're able to connect with a coach on demand or for parents and caregivers to be able to understand that they're not alone.

And they and both BrightLife Kids and Soluna do work with schools.

As I said, they have 391 educators that are a part of their educator ambassador program. They have partnerships with school districts throughout the state, including Los Angeles Unified School District and the Los Angeles County Office of Education.

I was with their director of student wellness and services yesterday, actually, at an event, and she was talking about the partnership that they have with, with Brightlife Kids in Saloona.

And one of the things I will say is that these programs, to your point, offer a lifeline to students and parents and caregivers, not just during school hours, but many of the services that they're providing are after school hours.

They're also after the hours where traditional behavioral health services are are not available.

Right? So it's not eight to five. Soluna is available from 10AM to 10PM every day, and Brightlife Kids is available for coaching from 10AM to 8PM every day.

And that is not something that you can get with one approach to be of our health delivery system. We need schools, we need communities, and we need a way for people to reach out in those moments where they really need it.

I am a parent of a child, she's 21 now, with severe mental illness. And I was watching my child grow through the pandemic, receiving intensive outpatient support, receiving was hospitalized for a brief period, receiving all of those in person services, including school based supports.

And I believe deeply that it was school based supports that really helped my child after the hospital visit that she had due to a suicide attempt.

But I also see my child in those moments where she's dysregulated, freaking out, and can now have somebody that she can reach out to seven days a week.

And that is not something that's available through any other means through the continuum of care for children and youth to be able to reach out, for parents to be able to reach out and not feel like they're alone or doing something wrong.

And so I understand the concerns, and we all want to make sure that young people have those face to face supports. They can get video based telehealth, by the way, which many of our school based providers also offer telehealth appointments.

Kaiser also offers telehealth appointments. Lots of other providers offer telehealth appointments, and that is the type of care that's being provided through Brightlife Kids in Soluna .

They also do chat based services for those quick check ins where folks need to connect and those, you know, real minutes.

But these kinds of support are absolutely important especially when kids and families don't know where to turn, and that's what we're hearing with Brightlife Kids in Soluna .

70% of Brightlife Kids users and more than half of people that come to Soluna had no contact with beaver hall delivery system before coming to those supports.

And with these programs, over 5,000 people have been connected families and youth have been connected to in person community based supports because of the care navigation and the design of the program that we heard from children, youth, and families we should have,

and that's why we built that into the way that these programs operate.

Thank you. And and I'm very sorry about your daughter.

She's doing good.

Yeah. Good. Good. Good. We love that.

So what how does this work in terms of funding? Because we're kind of at this 120,000,000 a year price and it's clearly growing. More people are signing up. So, you know, I know my kids sees ads all the time. Like, there's a lot of money going into advertising These programs.

Do is there is it like a pass through how does how does the pain for all of this work? Because as there's more and more people signing up and getting coaching appointments and and connected to services and all of those things, how is it not costing more this year than last year?

So the way that we structured the contracts for both BrightLife Kids and Soluna , which by the way, again, the amount that's proposed in the governor's budget only includes BrightLife Kids Soluna , and CalMAP, which is our pediatric consultation service and a part of the portfolio.

So it's not just BrightLife Kids and Soluna , but it does not include additional funding for all of the marketing and things that we've done.

That was all necessary for the launch of these programs to get the word out, to get you know, to your point, there's still people who don't know about it, but we're not making those additional investments in all of the education campaign.

But in each contract, there is a small amount for marketing and promotion of BrightLife Kids in Soluna. And the way that we structure the contracts is that as utilization goes up, the amount that we give them for promotion and marketing goes down.

It does not actually go up because more people know about it, the less they they have to advertise. So the higher amount for marketing was when less people knew about it, and as more people know about it, the amount for marketing comes down. Thank you.

Thank you. Any other I see no other questions up here. I just have one question which is around data protections. I've done a bit of work around student data protections and I was just glancing through the privacy policy.

One of the things that says though, at least for Soluna, is they can change the policy anytime they want to. So I'm wondering, for a program like this, the amount of money we're spending, state dollars, taxpayer dollars, how children's data is protected, and how you're monitoring that?

Yeah. Thank you. So I'll say, I have notes on one of these pages. Some are for Salinas specifically. They, in addition to to following all of the state and federal privacy requirements, and again, they are a they're a health care company, Kooth, who operates Soluna,

has been operating for over twenty years as a health care company in The UK.

They've also now branched out into The United States. So first in California, but they're in other states as well. And just like all telehealth companies and health plans and other providers, they have very strict requirements that they have to meet in terms of data privacy and security.

So the notice of privacy practices, does say that it could be changed at any time, but that's true for all health care providers, frankly.

They still have to comply with all state and federal privacy rules, but the COO team, in addition to that, also got additional certification of their data security and privacy to provide some extra assurances, around the privacy and security of data and the platform for Saluna specifically because it is for teens and young adults.

And they and there's been questions, so they wanted to make sure that they were doing everything that they can, which includes, by the way, not just the initial certification that nobody looks at it again, but regular reviews of their security. We also monitor security.

So anytime there's any platform breakdowns, not even breaches because that has not happened, just to be clear. But anytime there's degradation of the platform, our team looks at it.

Our information security office is involved with my team to make sure that the security maintains the level of security and privacy that is required. They have to submit regular updates to their security plan. Both BrightLife kids and Soluna do that, and we monitor that on a on a very regular basis.

And so I can give you the details. It's in here somewhere, I think, but we'll follow-up in writing with the details of the specific certification that Soluna obtained for that, but but they are health care providers, both of them, BrightLife Kids and Saluna.

And they follow all of the same data privacy and security rules as every other health care provider in California.

Except that they're not all health care providers, so the coaches are actually not certified anything.

Yes. They are. They're certified wellness coaches.

Well, they're not certified mental health providers within Soluna. Actually, their their online thing says they're not certified. So I guess I would like more detail and more information follow-up on that on how the data is protected.

If a child is sharing information with a coach and a coach is not a medical professional, how is that data protected?

Sure. And we're happy to provide the qualifications of the coaches. They are health care providers. So they're paraprofessionals. They are not licensed practitioners.

They are certified wellness coaches that are required to have either a state or national level certification in health care coaching, which is a recognized field both in California through the Department of Health Care Access and Information, as well as the California Mental Health Services Authority

with the peer support specialists. Many of the folks that have gone through Cal Mesa's peer support specialist program, some of those are working as coaches. Some of the wellness coaches through HCHI are working as coaches.

The same people that are working in schools. And they do they are required to have certification for that profession, and they are overseen by a very robust clinical team of licensed practitioners.

And the data security and privacy pieces apply to all of the providers. They're all required to cover comply with HIPAA, the California, Medical Information Act, all of the other state and federal privacy requirements as health care providers as are the the licensed folks who oversee the clinical operations of both programs.