Assembly Budget Subcommittee No. 1 on Health, Monday, May 4, 2026
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Assembly Budget Subcommittee No. 1 on Health California State Assembly
Follow its sittingsSpeaker 1
So we know this is serious in California, And more than one in five California adults has a mental illness, with less than eighty percent 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 one is going to take us backwards because of the significant reduction in Medi Cal 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 one. So today, this this subcommittee has invited families impacted by Anosognosia 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 atas.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 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.
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 going to move into the first panel and I'll welcome our panelists up to the table. 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 have Antoinette or Tony Navarro, director of behavioral health wellness from the county of Santa Barbara, and we have Michelle Doty 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 Don Marie, then we will move second to doctor Liundra, third to Tony Navarro, and fourth to Michelle Dodi 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.
Speaker 4
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 stabilized and 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 twenty six years. He lives with schizoaffective disorder, grandioseous personality disorder, and was born with autistic markers. But what has made all of this even harder, something may people still many people still don't understand, is 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, 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, 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 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 times 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 going to 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 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 them 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 AB1109, 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 CareCourt. CareCourt's a voluntary program that those with anosognosia, are they gonna agree to go to CareCourt? 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. Anasognosia 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 ends 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 the staff, anyone that would listen.
We took this book, 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, wished 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.
Speaker 3
Good evening. I was going to say good afternoon, but we are past that. Thank you so much for holding this hearing and for this really important topic. It is one that is not discussed often. I am Doctor.
Leandra Clark Harvey. I am the CEO of the California Behavioral Health Association. We represent providers that serve over 2,000,000 Californians. We are a 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.
Anosognosia, 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 anasognosia 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 someone 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 one raises some serious concerns in this context. If Medi Cal 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 Medi Cal 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 anasognosia 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.
Speaker 1
Thank you so much. And Thank you, Leandra. Director Navarro, when you're ready.
Speaker 5
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 thirty five 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 thirty five 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 and as agnosia, 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 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 in education among our managed care partners to ensure that their networks of providers, are part of the full spectrum of medical 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 inReach 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 ninety day window, and they may even be eligible for federal Medi Cal 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 of 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 Medi Cal 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 Medi Cal 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, SENCAL 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 SENCAL 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 SENCAL'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 h r one will stop that progress in its 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 h r one 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 will 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 Medi Cal safety net, families will be thrown further into the abyss. Thank you.
Speaker 1
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.
Speaker 6
Perfect. Thank you so much, Madam Chair and members. First, I want to thank Ms. 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 Ms. 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 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 failing 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 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 Ms. Anderson's. However, so many of the programs and services that do work like specialty courts, diversion, outreach, etcetera are not Medi Cal reimbursable. With the potential loss of tens of thousands of Californians losing their coverage due to HR1, 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 Brunson McCorkadale 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 one 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.
Speaker 1
Thank you so much. We're going to turn to the committee. I have a couple questions, but I'll open it up to my panelists or my committee members, see if anybody else has any questions. Please. Assembly member Stephanie, please.
Speaker 7
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 am 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 anisenotia 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 after an eight and a half 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 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 Mikayla Aliodapir 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 a 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 Supervisor Mark Farrell took over, and everyone thought it wouldn't work.
But assistant outpatient treatment, the black robe effect, showed that it was working. And I actually have a bill that I introduced, AB sixteen seventy six, that's going nowhere this time around. And that would allow for involuntary medication orders with assisted outpatient treatment. And it's not going anywhere because of 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 anisenotia 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 aren't they here to talk about everything that we have faced trying to get people the help that they need and every barrier they have put up?
So I promise you, Don, 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.
Speaker 1
I 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 CaliAM. 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 Medi Cal reimbursable. And so what's working, what's missing, and the no wrong door system that
Speaker 6
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 introduced that
Speaker 6
a new Medi Cal benefit. It was handed to the managed care plans based on the philosophy or the idea that 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 want to be clear because 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 Newsom administration do hold a lot of promise to improve access for people.
But I would argue that not enough people are being served in non specialty 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 acting injectables. And the health plan said, no way, I don't want to 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 going to 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 HR1 and BHSA happening at the same time, counties are going to 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 mention 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 Ms.
Anderson has had to endure.
Speaker 3
I would just add very briefly to that. Agree with the comments and I think that's why this panel is so important because what we've been experiencing is 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. 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 seeing. 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.
Speaker 5
I I just wanted to add that I I I think, again, I 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 Medi Cal 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. Well, 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 SENCAL for 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 SENCAL 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, you know, pushing the managed care plans to to really look at that in a different way. Under the Mental Health Services Act for the 20, 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.
Speaker 1
Thank you. I I appreciate that. It's a, that's a complex topic. Obviously, if you've been working on it twenty years, and I know, Don, you've been working on it since the nineties. I didn't know if you had anything else to add on this in particular.
Speaker 4
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.
Speaker 1
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 yeah. 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 Schiavo, actually.
Speaker 10
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?
Speaker 6
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, you know, 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 non specialty or, again, I'm just going to say it one more time, private insurance companies that have nothing for us with job based coverage. Nothing. 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 Medi Cal coverage.
Speaker 1
Seeing no other questions here, we're going to open to public comment for this issue. If you could state your name, your organization, and your position on this item. Thirty seconds.
Speaker 11
Good evening, madam chair and members. My name is Elise Jones. I'm the director of 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.
Speaker 1
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 I have a little bit of, tough feedback, I guess, I'll say for for some folks on this panel that this subcommittee has requested the administration provide 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 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 subcommittee so that we could digest ahead of this hearing. So in my opinion, these are not unusual asks or burdensome asks or even difficult asks. It's sort of the minimum that we would expect for the administration to have sent to us or shared with us as a co equal 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 a 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 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, you know, 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.
Speaker 8
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 and 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 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 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, fifty percent of all lifetime mental illnesses start to show signs by the age of fourteen, and seventy five percent 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 and community defined evidence practices, implementation of new Medi Cal 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 supports 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 and Saluna. These are not the only programs that are a part of the virtual services platform's portfolio, but we'll focus our attention, on those for today.
California is, this is a first in the nation 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 and 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 Bright Life Kids and Saluna, 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 one point four 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 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 in the continuum. BriLife Kids and Saluna 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. Most common reasons that families turn to BrightLife Kids include stress, worries, and anxiety, attention and ADHD, social emotional skills, self esteem, sadness, and depression. And the most common reason that youth turn to Saluna 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 and Youth Behavioral Health Initiative, and families in lower resource communities, rural communities, are accessing care through BrightLife Kids and Saluna.
There's representation across all 58 counties in California with users in every county. Fifty two percent of Saluna users and seventy three percent of BrightLife Kids users identify as black, indigenous, or people of color, and fifty five percent 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, eighty nine percent of children who engaged in coaching showed improvement in mental health symptoms, and eighty three percent of caregivers reported reduced strain after using BrightLife Kids coaching services. Additionally, for Saluna, eighty five percent of users reported having at least one of their needs met in a single session, and ninety eight percent reported feeling heard and respected by the Saluna coaches.
Ninety percent 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 study 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 improvements 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 and Saluna offer them a front door solution that will get them connected to community gay community based care and sports. 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 launch, BrightLife Kids and Salina 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 stakeholder perceptions of Saluna conducted completely independently of DHCS and Kuth 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 Soluna 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 and Saluna, and nine sixty three telehealth coaching sessions have been delivered, through 01/31/2026. BrightLife Kids and Saluna have three affiliate network providers in Monterey County and provide closed loop referrals 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 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 closed 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 two one one LA, Los Angeles Unified School District, LA County Department of Mental Health, YMCA LA, 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 Saluna 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. Solano 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 Solano 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 Saluna Family Voices, which includes 45 parents and caregivers, to help shape Saluna 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 Saluna safely, equitably, and effectively across California. And in February 2026, a report about CYBHI investments, Children Now highlighted BrightLife Kids in Saluna 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 to date. 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 and Salina. Both the California Department of Education and the California Surgeon General have endorsed BrightLife Kids and Saluna, and both apps have high ratings from users in the app stores.
The governor's budget proposes to continue funding for BrightLife Kids and Saluna, as you noted, as well as the CalMAP program, which is a part of that same portfolio. For BrightLife Kids and Saluna, the cost per active user with the contracts just for BrightLife Kids and Saluna 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.
Speaker 1
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.
Speaker 8
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 Keane 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 Medi Cal 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 December 2024. Since then, the number of LEAs, colleges, universities, and school linked 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 five zero five LEAs and community colleges are indirectly participating 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 College's chancellor's office, to help support the California Community College's implementation efforts. The goal is for all of the public t k through 12 schools and institutions of higher education to participate in the program and provide them a permanent source of funding 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, 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, 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 one forty four past last year or 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, eight health plans with an additional 12 onboarding capabilities in the next three or four 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 student's health insurance information. In April 2026, DHCS launched the new Medi Cal matching data process, to allow LEAs and colleges and universities to submit student data that will be then matched with the Medi Cal eligibility database to identify assigned Medi Cal MCP for that member. Six LEAs have already taken advantage of the new Medi Cal matching procedures world resulting in 23,000, records matched 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 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 stakeholder, stakeholder forums, DHCS has heard from county offices of education, local educational agencies, and others that it would be helpful to, develop additional guidance and tools for local implementation. In response, DHCS and Carol Anne 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 in supporting school counselors, including scenarios for billing for these support services. Additional toolkits 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 the LEA Bot program. It is not the same kind of monitoring and oversight mechanism for the CYBHI fee schedule program.
In the twenty twenty five-twenty six school year, in addition to the significant growth in claims volume and reimbursements described today, DHCS and Carol Anne 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 lead or independent LEAs have completed the administrative onboarding steps required for submitting claims. And Carillon Behavioral Health has conducted over 1,800 individual one on one technical assistance sessions with two eighty two 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, c county offices of education and LEAs report numerous reasons for slower than expected uptick 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 pupil 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 health 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.
Speaker 12
Thank you, madam chairman Lee with LAO. We're aware of the information that was just shared by the the department. We will review it as well as the update shared here today and be available to answer any questions.
Speaker 1
Nothing else. Okay. I I think I'm gonna start with the fee schedule, and I know there's questions on on platforms as well. Could you repeat the numbers? I know you said my county is so, 204,000 to Monterey County, 30,000 to San Luis Obispo County, and how much to Santa Cruz County?
Speaker 1
That's okay. And then you said through the Medi Cal matching program, 23,000 students have been matched statewide. Yes. Yes. So Monterey
Speaker 8
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, ninety eight thousand nine hundred and twenty five.
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 numbers for Los Angeles County.
Speaker 1
And what's the cost of administrating the program? I'm sorry? The cost of administrating the program.
Speaker 8
The the it's the what we, is in the budget from the 2025 Budget Act is $69,300,000.
Speaker 1
So I I just I just wanna I just wanna make sure I understand this. The program costs something like $70,000,000 in 2526. Just for my three counties, they've gotten back maybe 330,000?
Speaker 8
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. 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 and 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 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.
Speaker 1
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
Speaker 1
It was pretty much the exact same talking 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. When 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 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's 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 zero to five 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 into this particular program.
And so I'm I'll 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 may I respond? Sure. Sure.
Speaker 8
Okay. Thank you. I'll I 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 seventy percent of claims that are denied, are for a correctable reason. And so Caroline 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 Caroline 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 three hundred and sixty five days 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 one forty four 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 Carillon 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 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, 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 in 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 in Youth Behavioral Health Initiative, so zero to twenty five. 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 aged 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.
Speaker 10
Thank you for the update. I wish we had gotten data more than thirty minutes before the hearing.
Speaker 10
We're trying to add some numbers and do some things right here on the spot. So I appreciate I guess, I'll start with the fee schedule piece. I appreciate the comment around doing some education and education campaign. 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 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 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.
Speaker 8
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.
Speaker 10
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?
Speaker 8
Yes. Actually, so for the amount reimbursed, since July 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 a 181 LEAs that have submitted a claim for reimbursement and 177 that have received reimbursement under the program.
Speaker 10
Okay. And and So is this I know there were different cohorts. Yes. And are there it goes up to cohort four. Is there cohort five or six or seven?
Or how many cohorts do we have? Because I see you know, some counties are not on this list.
Speaker 8
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 LEA 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.
Speaker 10
And and at the end of the six cohorts, it's gonna be a 100% of the school districts? Or No. They have to optionally choose to participate? They do have to optionally choose to participate. There's no
Speaker 8
mandate on the school districts to participate. But but, no, it won't be a 100%. That that number of 72%
Speaker 8
And 50 out of 58 is through all six cohorts that have been announced. So there will
Speaker 10
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, I see the denial rate is kinda all over the place. I hear you saying 14%, but some have a denial rate of 80%, 55% Correct. 99%, 37%. And so it seems like there's a learning curve here.
Are so on any denials, the third party is following up with the school district? Correct. Okay. Okay. I think that's all of my questions for that.
Speaker 1
On the fee schedule? Not on the fee schedule. Do you do Maybe my let's do fee schedule and then Sure. Okay. Any questions on the fee schedules?
Okay. Let's move on then to the behavioral health platforms. And then after member questions finish, we'll take public comment on both parts of this item.
Speaker 10
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 have almost none of the school board members I talked to knew about this at all, Soluna or Bright Life Kids. And both in my district and here in Sacramento since this is where my kid goes to school. So, you know, the do you I I saw the very shiny, fancy presentation with the data on it, but and there's a whole lot of little boxes with numbers. Mhmm. Is there do you have numbers on I heard you saying how many people signed up.
But do we know what percentage of people are using it multiple times regularly? What is the data on usage?
Speaker 8
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 Saline 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, you know, 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 Saluna, 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.
Speaker 10
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? Is you know, sounds like it's still unclear. So, you know, my concern and to the point the chair made earlier is just how much cumulatively we have invested in this. And, you know, I have I have a few concerns.
One is that this is is an avenue to get support, but but we are funding and creating a lot of avenues to get support. And, you know, having school social workers on schools has been a huge improvement. And, you know, one some of the feedback that I got from one of my districts was that one school district said, you know, 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, you know, 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, you know, it like, everything that we're seeing in mental health, I don't know. It just seems so counterintuitive.
And 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 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, you know, I wish I wish we had started smaller and been able to have more progress happen than just throw a ton of money at it and, you know, 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, you know, when when we could be making investments in more school social workers and things that are those face to face connections that, you know, 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, you know, and I 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, you know, I I hope that, I hope that we can figure out a balance to that because I just I just I 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 but it's when we have to prioritize limited dollars, you know, the in person social worker is going to win every time for me.
Speaker 8
I will. Yeah. Thank you. Very briefly. I 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 Bright Life Kids and Salina 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 Saluna. 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. Luna is available from 10AM to 10PM every day, and Bright Life Kids is available for coaching from 10AM to 8PM every day. And that is not something that you can get with one approach to Beaver 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 you know, 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 I 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 and Saluna.
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, when kids and families don't know where to turn, and that's what we're hearing with BrightLife Kids and Saluna. Seventy percent of BrightLife Kids users and more than half of people that come to Saluna had no contact with behavioral health delivery system before coming to those sports. 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.
Speaker 10
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 I know my kid sees ads all the time. Like, there's a lot of money going into advertising Mhmm.
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?
Speaker 8
So the way that we structured the contracts for both BrightLife Kids and Saluna, which, by the way, again, the amount that's proposed in the governor's budget only includes BrightLife Kids, Saluna, and CalMAP, which is our pediatric consultation service and a part of the portfolio. So it's not just BrightLife Kids and Saluna, 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 and Saluna. 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 the 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.
Speaker 1
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 Salinas, 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.
Speaker 8
Yeah. Thank you. So I'll say, I have notes on one of these pages. Some are for Soluna 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.
Kuth, who operates Saluna, 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 COOT 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 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, then 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 Salina do that, and we monitor that on a on a very regular basis. And so I can give you the details.
It's in your summary, I think, but we'll follow-up in writing with the details of the specific certification that Saluna 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.
Speaker 1
Except that they're not all health care providers, so the coaches are actually not certified anything.
Speaker 1
They're certified wellness coaches. Well, they're not certified mental health providers within SLUNA. Actually, their online thing says they're not certified. So I I guess I 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?
Speaker 8
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 HCAI 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.
Speaker 1
I would like follow-up information on on on that because I think a little bit of what I was reading on Saluna and what you're saying aren't an exact match. Great. So I'd like to I'd love to have that information. I think the overall message here is there's a lot of concern on the part of the legislature about ROI on these dollars in particular. When we look at a $640,000,000 over the over the lifespan of this program, It's very expensive for the number of people being served and wanting to make sure that we're really getting out of the program the promises that have been made if we're gonna continue to fund this program.
Oh, please, assembly member.
Speaker 7
Yes. Thank you, chair, and thank you for the presentation. And I do wanna echo the concerns of my colleagues. You know, I just feel like in terms of the amount of money that we're spending, the clinical outcomes seem very opaque to me. And it's just how it's sitting with me in terms of what's been presented and the little that I do know and the fact that I did check-in with my school district, they don't seem to know about it in San Francisco.
And I also get concerned about the heavy reliance on private vendors for public health services. And I don't want to get into a situation where we think that we are actually serving our children. I I think that the idea is the idea around this is good. We're trying to fill gaps. But at the same time, I don't want to be putting a Band Aid on therapist shortages, long wait times, insurance barriers, things that are really causing systemic issues in our mental health delivery system for our children.
Speaker 7
I just don't want us to get into a situation where we're undertreating the serious problem of mental health challenges for our youth. And with the lack of information, I feel, around positive outcomes clinically, it's hard for me to see the justification for the large dollar amount and to understand exactly the breakdown of the dollars, where they're going to, who is going to a bright life, who is going to a saloon, how much does a coach get paid. A coach is not a clinical therapist. For me, I have more questions now than I did when I came in. So I definitely wanna make sure that we continue to follow this and see if we can justify these dollars.
Speaker 1
I'll just add the other big takeaway I'd say is that if the program's as good as as as we're you know, you're testifying that is, that we should have gotten the we should have received the data on this two months ago when it was asked for. We asked for data in March. We got data maybe yesterday, last week. So there's problems there in terms of showing the efficacy compared to saying what the efficacy is. And so I hope you'll take that as one of the big takeaways from this hearing.
But with that, we're gonna open up to public comment for this for both for all of the items under issue number two, the fee schedule, as well as the behavioral health apps. And if, you could share your name, your organization, your position on these issues in thirty seconds or less. Thank you.
Speaker 14
Good evening. I'm Michael Sargos on behalf of the California Farmworkers Foundation, here in support of the Saloon app within the CYBHI. For us, as you probably know, Farmworkers, hard to serve. We don't work traditional hours. The the app really allows us to serve our constituents in a way that we wouldn't be able to, especially now in a time where we have federal immigration issues.
This allows them to be able to seek that mental health treatment in a way where they don't have to go into an office. So we think it's extremely helpful within the regions that we serve, which is Central Valley, Central Coast, Coachella Valley. We have about 30,000 people that are, using the application, about 1,500 in Monterey, and about 1,800 in San Luis Obispo. So we know there's more to come. We think it's a good program, and we hope you continue to fund it.
Thank you.
Speaker 15
Good evening. Nora Angela is with Children Now. California has invested 4,100,000,000 in CYBHI, reaching more than 31,000 students with mental health services. At the same time though, HR one gets the federal funding that makes the system possible, leaving youth who need behavioral health services the most nowhere to turn. We need a clear plan to reach the millions of students still not being served.
Thank you.
Speaker 16
Thank you, chair members. Sarah Bridge on behalf of the Association of California Healthcare Districts as well as the All Cove Network. On the CYBHI fee schedule, we are here in support of that. Though it's been a long road over the past year, those All Cove Centers have been able to integrate as school linked providers and are now successfully billing the fee schedule. See it as an important part of the initiative.
However, on the second part as it relates to the apps, just wanna underscore actually, in fact, represented here are the members here today. We have 11 All Cove centers that are serving, thousands of youth across the state, that are at threat. We are asking for a onetime appropriation of $24,000,000. One center alone in the Greater Los Angeles region has served 13,000 youth who provide over two two thousand services. Thank you.
Good
Speaker 17
evening. My name is Nora Kaneti. On behalf of the CCPoED and the Central Valley Latino Elected Officials Coalition in support of the Soluna platform within the CYBHI, which is child and youth behavioral initiative. Thank you.
Speaker 18
Good afternoon or good evening. Anthony Butler Torres on behalf of the California Hispanic Chambers of Commerce in support of the Soluna platform within CYBHI. Thank you.
Speaker 4
Good evening, chair and members. My name is Diane Ordaz Charington. I am representing Southern California Healthcare Advocacy Coalition, and we strongly support CYBHI. Thank you.
Speaker 19
Good evening, chair members. My name is Roberto Arnold, and I'm representing the California's the California Multicultural Business Alliance and the Latin Business Association in support of CBYA. We wanna make sure that we keep supporting the app support that Saluna brings. We represent over 3,500 businesses throughout California, and a lot of our minority, underrepresented communities have really utilized this. We really appreciate the support.
Speaker 1
Thank you. Seeing no other, public comment, we're gonna move to issue three, which covers two proposals related to the oversight of nine eight eight call centers as well as a proposal to recast community based mobile crisis response as an optional Medi Cal benefit beginning 04/01/2027. We have another of panelists. So if LAO doesn't mind, thank you so much. Panel one is on nine eighty eight and then we'll do member questions move to panel two on mobile crisis.
So we're gonna welcome DHCS and then, Nargis Dillon, nine eight eight California president and of the nine eight eight California Crisis Center Consortium. Then Elise Jones, county behavioral health director, Lake County. And then we will welcome back Doctor. Leonda Clark Harvey, Chief Executive Officer of California Behavioral Health Association. And we will ask you to please keep your comments brief if you can.
I am sure your written notes are much longer than we have time for this evening. So if you can truncate those a little bit to get your point across, I know that we would be grateful.
Speaker 20
Evening. I think I get to start us off. Paula Wilhelm. I'm the Deputy Director for Behavioral Health at the Department of Health Care Services. And I also have my colleague Ivan Bardwaj with me to help with questions on nine eighty eight as he leads our work there.
Thank you very much for your interest in California's nine eighty eight implementation and for the detailed questions included in the agenda. I think in the interest of time, what I can do is share a brief overview of DHCS's proposed nine eighty eight trailer bill language and budget change proposal, and then I have detailed responses to all of the committee questions, but I think I'm gonna start with the first three if that's okay, and then you're welcome to double back in Q and A if you'd like to hear about the others. So our proposed nine eighty eight trailer bill authorizes DHCS to establish a new statewide designation process for California nine eighty eight suicide and crisis lifeline centers. The goal of this proposed designation process is really to create a pathway to add new nine eighty eight centers and improve nine eighty eight response capacity in light of increasing call, text, and chat volume, and to specify standards that all centers will meet going forward to continue receiving nine eighty eight funding. The nine eighty eight center designation process proposed in the TBL will be implemented no sooner than 10/01/2027.
All existing California nine eighty eight centers must obtain the DHCS designation approval by 12/31/2029, and DHCS looks forward to supporting and collaborating with existing centers on this effort so that they can become designated as proposed. The agenda did note stakeholder concerns about the way the trailer bill describes the 12/31/2029 transition date. We appreciate the opportunity to clarify this. The intent of that language is really to specify that current nine eighty eight centers will continue receiving funds from the nine eighty eight Fund until 12/31/2029. After that date, only centers that have obtained DHCS designation approval will receive funding from the nine eighty eight fund.
So we are not proposing to expand the allowable uses of the nine eighty eight fund either before or after that date. This language was intended to be a technical language to clarify that after 12/31/2029, no non designated centers can continue to be funded. So we certainly welcome any feedback on how we can clarify that language or the intent. Our proposed trailer bill would also define what qualifies as a designated nine eighty eight center, describe what is meant by a mobile crisis team, and clarify how funds from the nine eighty eight suicide and behavioral health crisis services fund will be allocated. So the budget language that we put forward really offers a framework for nine eighty eight center designation and also authorizes DHCS to establish statewide operating and quality standards for our centers that address requirements for things like staffing, training, clinical and triage protocols, center performance, and DHCS's oversight and monitoring.
But the legislation, as is typical, is a framework only. So DHCS's plan would be to work with the existing centers and other stakeholders prior to the 10/01/2027 implementation date to fill in the framework and establish the full details of the designation process and standards for the centers. And then we have a budget change proposal that is oriented around completing the work outlined in the TBL and also addressing the growing operational demands of the nine eighty eight system. We So are requesting resources to support DHCS's statewide oversight activities and then also local assistance funding to support direct continued operation of our existing eleven nine eighty eight crisis centers. And as you can see, our BCP request included, the following specific amounts.
So for local assistant local assistance expenditure authority, we're asking for 19,400,000 in addition to an existing 12,500,000 in ongoing authority. And again, this is to directly support nine eighty eight center operations in fiscal year twenty six, twenty seven, and through fiscal year twenty nine, thirty. And then on the state operations side, we're requesting 3,000,000 annually to support a contract for our nine eighty eight administrative entity in fiscal year twenty six, twenty seven and ongoing. 2,000,000 annually to support a contract for a program certification consultants to help implement the designation process from fiscal year twenty six-twenty seven through fiscal year two thousand nine hundred and thirty and then 1,400,000 in fiscal year two thousand six hundred and twenty seven and 1,370,000 in fiscal year two thousand seven hundred and twenty eight and ongoing for eight permanent positions within DHCS to manage our nine eighty eight responsibilities. And we'll just underscore that the requested local assistance funding is really critical to ensure that the nine eighty eight system has capacity to manage growing call chat and text volumes and avoid delays in crisis response.
And then the DHCS resources are needed to implement the provisions of the trailer bill including the new designation process and to perform ongoing statewide oversight of our centers. So I'm gonna go ahead and pivot and if I may answer the first, I believe, three of the questions that the committee put forward.
Speaker 20
back and see if members still have questions. Great. So the first question was about current performance standards for nine eighty eight centers and whether the centers are meeting those standards. And we do closely track nine eighty eight center performance using key performance indicators or KPIs that are established at the national level under SAMHSA's nine eighty eight suicide and crisis lifeline agreement with states. The KPIs help us understand how reliably calls, chats, and texts are being answered across the state.
So core metrics we monitor include the answer rate, which reflects the percentage of routed contacts that are answered in state, the average speed to answer, the abandonment rate, and that is the rate at which callers may disconnect before they make contact, and then finally the rate at which contacts that are not answered in state roll over to the national backup centers. So when we look at performance over the past twelve months from April 2025 through March 2026, California's average answer rates were 87% for calls, 33% for chats, and 35% for texts. So the national standard is that answer rates for all of these contact types exceed 90% as you can hear we're nearly achieving that for calls but have room for improvement with chats and texts. And so I also have the numbers for some of those other metrics but we'll hold those for now and come back to them if you'd like to hear more. I would also want to note that these performance targets are not really tied to compliance actions so the way we approach this is to review the variances and trends with SAMHSA and with our nine eighty eight center partners and our administrative entities.
We try to provide training and technical assistance and then I'll talk a little bit about how we endeavor to take this into account as we propose funding for the centers going forward. So another question that you had was about how we project demand for nine eighty eight services and that really sort of ties into how we project funding and propose the funding level in our budget change proposal. So I think we just want to highlight that we know demand is increasing, however it is hard to project precisely because the growth is also nonlinear driven by things like increased diversions from nine eleven that can be unpredictable but also rising public awareness over time of nine eighty eight as an option. And so for to illustrate this, in March 2026, our nine eighty eight crisis centers received more than 74,000 routed contacts. That represents roughly a 131% increase in monthly volume since the nine eighty eight lifeline launched in July 2022.
But again, that's not been steady or linear. So one of the things we are working on with the help from our administrative entity is a refined and updated multi year projection model that really looks at long term contact volume now that we have a few years of experience to draw on and then can inform our funding needs and capacity planning. And I think that gets to the sort of last thing I will cover which is the committee asked about our proposal proposing 31,900,000 annually in direct support for the nine eighty eight centers and then the nine eighty eight consortium having identified approximately a 105,000,000 annually and sort of what is the difference between the two proposals. And so the department's budget change proposal is really structured to sustain the center's current capacity, and we start to do those calculations based on actual past operating expenditures. So we look at the historical cost trends and then we try to incorporate incremental growth or performance based incentives that we hope can help strengthen answer rates.
So again that 31.9 or 32,000,000 level is really based on the existing operational footprint and it doesn't include broader goals for expansion or staffing increases or performance improvement that are no doubt reflected in the consortium's 105,000,000 estimate. So what we would expect to see under our proposal is that the overall performance can remain stable, again, with relative answer call answer rates that are you know close to the national standard and certainly comparable to or exceeding the performance in other states, and we hope we'll be able to see some gradual improvement in the chat and text availability. So I hope that context is helpful as we hear from others and take questions. Thank you.
Speaker 1
Great, thank you. And I will hear from Nargis Dillon next. Yeah, please. And if you can truncate a little bit.
Speaker 21
Yeah. Good evening, chair and members. Thank you for your attention to the sustainability of California's nine eighty eight system. My name is Nargis Zohori Dillon. I'm here as the president of nine eighty eight California Crisis Center Consortium, representing California's eleven nine eighty eight suicide and crisis lifeline centers.
I also run one of those centers in Alameda County. All of our centers provide 20 fourseven telephone support, and many provide 20 fourseven chat and text services for Californians in their moments of crisis or worry about a loved one. Since the transition to nine eighty eight, the number of help seekers reaching out to us has consistently increased. Comparing January 2025 and January 2026, the incoming call volume to California's nine eighty eight centers increased by 37.7%, while the incoming text and chat volume increased by 26.7%. Our counselors don't just answer phones, they provide in the moment de escalation, suicide risk assessment, safety planning, and direct links to appropriate level of care.
This includes referring to mobile crisis or emergency services. It is important to note that over 95% of contacts to 988 do not require an in person response. We know that 988 works. According to SAMHSA, users feel less depressed and more hopeful after speaking with a counselor. And just last week, the Journal of American Medical Association published a study finding that 988 is associated with eleven percent drop in youth suicides.
Specifically, this was linked to largest declines in states with largest call volume. Despite this proven impact, our centers face a significant financial shortfall. The DHCS budget change proposal today adds only 2,000,000 in local assistance. In the face of the nearly 38% volume spike, a 2,000,000 increase is effectively a disinvestment. The like, maintaining the current capacity guaranteed a continued continued not meeting of needs.
I wanna be very clear. Our request of a 105,000,000 is not a wish list. It's based on rigorous bottom up mythology. To arrive at this number, we calculated staffing needs based on projected volume, and we also accounted for local dynamics such as nine eleven diversion. We factored in staffing required to meet national follow-up standards, which is that any help seeker expressing suicidal or homicidal ideation during the contact or reporting it in the last twenty four hours should have a follow-up.
This is labor intensive, life saving intervention. We use conservative 60% acceptance rates for follow-up on calls and 45% acceptance rate for chats and texts based on real world data. Lastly, the factor that's creating such a large gap between the current funding and the reality of our projection is the text and chat coverage. Currently, less than 45% of California's text and chats are answered in state because of funds not keeping pace. When a California teen texts for help and it's routed out of state, that counselor lacks the knowledge of mobile crisis teams or regional resources that is therefore more likely to contact law enforcement.
The safety gap must close. Most critically, the decrease of the nine eight eight surcharge from 8¢ to 5¢ in 2026 is extremely worrisome during a time of such sharp increases in demand. AB nine eighty eight allows a surcharge of up to 30¢. This dedicated funding source gives California a chance to deliver on the promise of September. Though we're not privy to the details of the current funding methodology between DHCS and Cal OES, the gap discussed makes it clear that the current system is not responsive to the continued reliance Californians are showing on nine eighty eight.
At a time of numerous stressors to the behavioral health continuum, nine eighty eight is literally a lifeline de escalating crises over the phone, preventing unnecessary high cost ER or traumatic law enforcement responses. We keep people out of jail and out of hospitals. Many of the California centers have been part of the lifeline for over twenty years. We support the state's five year implementation plan, but cannot build a comprehensive continuum of care without a strong foundation. The five year plan includes multiple goals specifically designed to drive up volume to 09/08.
The very first goal of the plan is to increase public awareness and trust in September. DHCS has already carried out a campaign in 2025, and California Department of Public Health has announced an upcoming campaign as well. Another major goal of AB nine eighty eight and the five year plan is diversion of calls from 911 to 988. The annual call volume of 911 in California is 26 to 29,000,000. Even a 1% diversion to 988 would create 250,000 additional calls, increasing the current call volume by 50%.
There's no way the system can absorb this kind of growth. We urge the legislature to allocate the $105,000,000 necessary to meet this immediate need in our state's suicide prevention system and to direct DHCS to create a funding methodology with input from the centers that accounts for growth in addition to other dynamics unique to this twenty four seven service.
Speaker 1
Thank you so much. That was exactly five minutes. You're a good you're a good example to everyone. Not to mention important information that you shared with us, which is actually the focus here. But we'll turn it over to director Jones from, County Behavioral Health in Lake County.
Speaker 11
with her personally, and I can definitely attest. We had a contract actually for many years before the whole nine eight eight mobile crisis thing, and and so it's good to see you here, my friend. Okay. So my name is Elise Jones. Again, I'm the director of Lake County Behavioral Health.
I strongly support 988, but 988 cannot just be a number people call. It has to be connected to an actual clinical response. A person in crisis does not experience 988 and mobile crisis as separate budget items. They experience one promise. When I call for help, somebody will answer.
And if I need someone in person, they will come. That is why funding and oversight must cover the whole crisis continuum, call centers, clinical triage, mobile response, and follow-up. I also wanna name the budget contrast before you today. This agenda includes continued major investments in CYBHI digital platforms despite limited outcome data. At the same time, we are discussing instability for nine eight eight and mobile crisis, services staffed by real teams responding to real crises with measurable outcomes.
If we can fund apps, we can fund crisis response. Please protect nine eight eight surcharge revenue, fund the full crisis continuum, and please do not re leave rural counties with a front door to a system that we cannot afford to operate. Thank you.
Speaker 1
Thank you so much. And we'll move to our last panelist, doctor Harvey, chief executive officer of California Behavioral Health Association.
Speaker 3
Hello again. I will try to be quick. I have crossed out a lot of things. I'm going align many of my comments with those of my colleague, Nargis. She did a very good job there.
I'm here to urge you also to protect and strengthen investment in the California nine eighty eight call centers. This system, as you have heard, is the front door to behavioral health care for thousands every day. When someone calls, texts, or chats 988, they're often reaching out in the most vulnerable moment of their lives, experiencing suicidal thoughts, substance use crises, trauma, or overwhelming emotional distress. And in that moment, one thing matters most, does someone answer? As you have heard from my colleague at the ninety day consortium, every day trained counselors are answering that call, de escalating crises, providing support, connecting individuals to care.
And the system is working and must continue to because as, deputy director Wilhelms, shared, most of those nine eighty eight contacts are resolved during the interaction itself, not needing extended help. This compassionate care that they're providing is also cost effective, but our system is under strain. Centers are also facing workforce shortages, delays in technology reimbursement, and uncertainty around long term funding. They also have weathered changes at OES leadership and a lack of consistent consultation with state entities before they make changes to their fees. The communication has to improve because when 988 can't respond, people will default to 911, emergency rooms, no care at all.
California made a commitment through AB nine eight eight to build a modern crisis response system, But that promise depends on whether we are willing to sustain it. So respectfully, providers urge the legislature to provide stable and ongoing funding for our nine eight eight operations, invest in workforce recruitment and retention, ensure timely reimbursement for technology and infrastructure, and talk to the centers about what that needs to look like. We need to build capacity so California can actually meet those national response standards because access delayed at nine eight eight becomes crisis intensified elsewhere. Thank you.
Speaker 1
Thank you so much. Anything else from DOF for Elio? Thank you. We work we're gonna we were gonna move straight to the next panel, but I'll just see if there's any 988 questions. I, I'll just make this one comment that I was having the same very similar thinking to what you said, miss Jones, about the juxtaposition between money that's being spent on a third party outsourced online app compared to, the proposal for nine eight eight.
And I think it's, I think the juxtaposition of these two proposals is something I'll say broadly to the administration. I think really, should maybe go back and and think about how one is funded and the other is completely underfunded and how that, could look in the May revise. It might look differently in the May revise. We'll move on then to our panel two on mobile crisis. We've got and we'll welcome our second panel up.
We've got DHCS. We've got May Sampini, executive director of crisis services of Pacific Clinic. So we may need to trade out some panelists, and I wanna say thank you to those of you that are trading out. We have Doctor. Clark is going to stay with us, the Chief Executive Officer, California Behavioral Health Association, and then Ms.
Jones is going to stay from Lake County Behavioral Health. So we'll start first with DHCS, move to Ms. Siampini, then Doctor. Harvey, then Ms. Jones.
Speaker 20
Thank you. And believe I can summarize this one quickly. So we appreciate, inclusion of mobile crisis services on this panel as well. I can share a brief overview of our mobile crisis trailer bill language and also some key background to help explain why DHCS is advancing this trailer bill. So under the Federal American Rescue Plan Act or ARPA, states were given a five year window between 04/01/2022 and 03/31/2027 to offer qualifying mobile crisis services with an enhanced federal Medicaid match of 85% for the first twelve fiscal quarters of service implementation.
This enhanced federal funding was always, intended to be temporary, and in California, that enhanced federal match is available specifically from 01/01/2024 through 12/31/2026. And then our California state statute, which originally authorized our mobile crisis benefit sunsets on 03/31/2027, so three months after that enhanced FMAP opportunity expires, and this is aligning our state law with the five year federal authority. So the proposed TBL would provide ongoing authority for the Medi Cal mobile crisis services benefit beyond that sunset date in March 2027 but at county option, and the bill language proposed also enables DHCS to redesign the benefit framework for community based mobile crisis response services as needed, all effective 04/01/2027. Because the enhanced federal match expires on 12/31/2026, the TBL will continue the benefit as an optional Medi Cal benefit with counties no longer required to provide the service. So counties that choose to opt in would be responsible for covering the non federal share of costs without relying on general fund support.
The trailer bill also provides flexibility to adjust the benefit design, as I mentioned, in part because beginning in 2027, coverage will no longer be tied to meeting the very high bar set in the American Rescue Plan Act. Namely, one of the things that our federal partners required to access the enhanced federal match was availability of these services statewide, twenty four hours a day, seven days a week, three sixty five days a year, no matter how rural or remote the area is. So that is something that we can consider as we move forward or if we move forward with a proposal to make the benefit optional. And then to touch on a few of the questions that the committee had, we saw questions about the proposed policy change and the overall impacts, impacts to emergency departments and other higher intensity and higher cost services based on whether counties will be able to cover the service at county option going forward. So I want to note that DHCS agrees that the mobile crisis benefit has shown promising results with more than 52,000 unique Medi Cal members having received a mobile crisis response service since early twenty twenty four, so that's about over a two year period and likely an undercount due to claims lag.
In many cases, we do expect this response likely avoided a more intensive level of care or a more expensive response. DHCS has not yet completed a formal analysis of potential impacts that could result from making this benefit optional by county and we have not begun planning any transitions in response to specific local coverage decisions. So we're actively listening to feedback received from our stakeholders and county partners, but we'll wait until any changes are enacted to formally survey counties or gather more data about opt in opt out status. We definitely recognize that counties differ in their capacity to support the non federal share once the enhanced federal match and general fund support ends and that all counties are facing increased demands for resources right now as a result of HR one and other pending changes. So we think it is really too early to determine what disparities might emerge, but we really appreciate county's commitment to investment in launching these services to date and the results that we have seen as they have rolled out this benefit.
So we would like to see many counties continue this. We're committed to collaborating closely with them, providing information, technical assistance, partnership, to the extent we can to support mobile crisis services going forward. Of course, we do have, requirements for other types of crisis services to be count, continue to be covered in Medi Cal. That includes things like crisis intervention and crisis stabilization. These crisis services are not interchangeable with mobile crisis response, but can support ongoing access to crisis services and continue to strengthen our continuum even as counties need to make this decision about whether to opt in or out of the mobile crisis benefit.
So we appreciate the discussion on this and of course the partnership from counties and providers, on these services, and we're happy to take questions.
Speaker 22
Good evening, chair Addison, the members of the committee. I'm Mason Pony, executive director of Pacific Lenox Statewide, Crisis Services. Pacific Lenox is a statewide community based mental health provider that helps people in crisis and provides ongoing behavioral health care across California. As a mobile crisis provider in Santa Clara County, Solano, San Benito, and Soon Nevada Counties, we work to ensure no one has to face a mental health crisis alone or without the proper clinical support. Prior to the mobile crisis teams, when someone were experiencing a mental health crisis in the community, law enforcement would be called.
While the police serves a vital role in public safety and responding to emergencies, a mental health or substance use crisis requires a specialized clinical response and often a warm handoff for additional support. Our system of crisis care now requires trained experts in addition to law enforcement to respond to critical and life threatening services. One of our mobile crisis teams in Santa Clara County that serves the adults is community driven twenty four seven, that serves, all of Santa Clara County. Trust is designed specifically for adult residents facing urgent mental health or substance use situations, ensuring that the response is rooted in care and clinical expertise rather than just public safety. Through trust, we are building a compassionate, effective, and urgent response system that saves lives and keeps families together.
I'd like to share a story from the field that perfectly captures why our mobile crisis team is so vital to our community. At around 10:40PM, we received a call regarding a 45 year old nonverbal autistic man. His mother, his only caregiver, had suddenly fainted while picking up a prescription and was rushed to Kaiser with stroke symptoms. This left her son alone, sitting in the passenger seat of her car, confused and unable to communicate. By the time our mobile crisis team arrived, police and EMS had already been at the scene for nearly two hours.
They were at a standstill. The only other family member they could find was a bed bound aunt who couldn't help, and the authorities were hesitant to initiate a hold because the client wasn't aggressive. He was just very scared and vulnerable and felt alone. Our team realized that traditional transport to a crisis center would be traumatizing and isolate him further from his mother. So our team coordinated a high level negotiation between EMS supervisor, police department, and the Kaiser ED charge charge nurse.
Kaiser agreed to take him not just as a patient, but to a play to place him in the same room as his mother so they could remain together. To keep him calm, we avoided the flashing lights of an ambulance. The EMS supervisor volunteered his own vehicle, and a team member sat in the back with the client providing comfort and a steady presence throughout the drive while another team member stayed to focus on logistics, ensuring that police the PD had the right documentation for a grave disability hold to ensure the client was legally protected and cared for. The result of this, a situation that could have ended in a high stress escalation or a lonely night in a clinical ward ended with a vulnerable man being safely reunited with his mother mother's care team without a single incident. The team didn't just clear a call.
They navigated a complex system to provide a human solution when the traditional system had run out of options. This example demonstrates the intensity of the situations we experience in the community as a mobile crisis team and Pacific Clinic's commitment to meeting people where they are. Just trying to it's important to note that these services are accessible to law enforcement, to schools, to community, families, community providers. So in conclusion, making mobile crisis an optional benefit would result will result in increased cost to counties annually, all while they are experiencing significant budget constraints due to h r one to balance their budgets. The state has made substantial investments to build out the infrastructure, workforce capacity, and systems coordination necessary to deliver this benefit effectively.
Scaling back coverage would risk undermining this investment, harm vulnerable communities, and lead to gaps in access to crisis services and negative outcomes for those experiencing a mental health crisis. So it is for these reasons that Pacific Lenox is wholeheartedly committed to ensuring mobile crisis remains as equitable statewide, services across the state, and we respectfully ask the committee to reject the governor's proposal to move this to an optional benefit. Thank you.
Speaker 3
Alright. CBHA is proud to stand alongside our county partners who fund and oversee mobile crisis services and many others, and our members like Pacific Clinics who deliver them in real time in communities twenty four seven. Mobile crisis is one of the most important places where this partnership is delivering real results, which is why we strongly urge the legislature to reject any proposal that makes mobile crisis optional by county and to preserve it as a statewide Medi Cal benefit. On a bad night, mobile crisis teams are the difference between stabilization and escalation as we just heard from my colleague's testimony. They literally meet people where they are at home, in schools, on the street, and provide care in the least restrictive restrictive setting.
This is exactly the system that California said it wanted to build. But if this becomes optional, some counties will sustain these services and others will be forced to scale them back or eliminate them. Access to crisis care will now depend on zip code. And when access depends on a zip code, inequity is not accidental. It is designed into the system.
So we are anticipating that we will see more people in crisis routed to 911 instead of care, more law enforcement responding to behavioral health crises they are not designed to manage. That is not system flexibility. It's system failure. California and its county partners have already invested heavily in mobile crisis building workforce, standing up twenty four seven response models, and creating partnerships across systems. Providers have hired, trained, deployed teams based on the promise that this would be sustained statewide benefit.
Rolling that back now since a destabilizing message. Shifting mobile crisis to a county optional structure without additional funding does not create flexibility. As California continues to implement Cal Aim and modernize care, this is the moment to strengthen the crisis continuum, not to create new gaps in it. We respectfully urge the legislature to maintain mobile crisis as a statewide mandatory Medi Cal benefit and to reinforce the county provider partnerships that makes it work. Thank you.
Speaker 11
you so much, madam chair. Again, Lake County, about 68,000 people, and I'd like to speak directly to the framing of mobile crisis as an optional benefit. The word optional implies choice. But for poor rural counties, this is not a real choice. We cannot afford to absorb the ongoing cost of a twenty four seven clinical crisis response system with local funds alone, and yet mobile crisis is foundational to our behavioral health care system.
In 2025, we received approximately 422 calls and completed about 1,300 field deployments. Of those, eighty three percent were resolved without a fifty one fifty or any further need for additional care. That means people were stabilized, as everyone else has said, in their homes and communities instead of clogging up emergency departments, taking up law enforcement time unnecessarily or resulting in higher levels of care. If mobile crisis becomes optional, access will depend on county wealth, not clinical need. This is not a statewide crisis system.
That is a patchwork network. And when rural counties cannot sustain it, the crisis does not disappear. Again, it shifts to other sectors. I heard the hope is that counties will find funding on a voluntary basis. And respectfully, madam chair, I cannot pay bills with hope.
Thank you very much.
Speaker 1
Thank you so much. Any questions? Assemblymember. I'll just start by saying this is probably one of the least popular proposals, that we've received feedback from on this budget subcommittee. I'd say there's dozens of members who have reached out to us as well as I think every single county across all 58 counties have have reached out to express their disappointment.
But was there anything from DOF or LAO before I say more?
Speaker 23
Yeah. Sabrina Adams with the Department of Finance. I think I'd just like to quickly note, we've heard a lot about a lot of concerns about sort of the federal impacts of HR one and sort of how that impacts our health and safety net programs across the state. We just like to note that we we share those concerns, and we we understand them. And so sort of the the conversations that we're having today sort of grapple with how there is a a state a structural state deficit that we need to address.
And so the conversations that we sort of have around that also need to address and sort of limit new spending to sort of, like, contextualize how so so sort of understand under sorry. Just that we can suspense responsibly and sustainably support our state's programs moving forward. And my colleague at Department of Health Care Services noted that the decision to recast the service as as an optional benefit sort of takes into consideration the expiration of that enhanced federal match and the broader structural deficit as a whole. And so that's sort of the place that this proposal is coming from. And so we really appreciate the partnership of this committee, just to work towards finding, a sustainable fiscal plan,
Speaker 15
and this is this is an option to sort of continue the benefit moving forward. Thanks.
Speaker 1
Thank you. I appreciate that. And it's getting late. It's hard for all of us to it's hard for me to get my words outside, but I I I appreciate that. I guess I would just say that, I think most people in times like these would wanna fund things at work.
And so we've heard some things this evening about programs that have data behind them, that have stories behind them, that have real lives that they're helping. And then we've heard some things this evening about programs that don't have that data, that aren't, that real human support, and I think there's frustration from members. You've certainly, been in the room this evening to hear my frustration about some of the funding decisions in the January 10 proposal that, I would hope coming out of this hearing would be revised going into the May revise. And what we see in the May revise will hopefully focus on the things that we're hearing that there's data that shows that it works and that it's a lifeline to real people in real time and that it's a it actually is California tax dollars at work and that we are able to substantiate that. So I don't have any questions, but I'll just reiterate.
This is, I think, this is one of the most unpopular proposals, in terms of feedback that we've gotten again from sometimes we get feedback from counties as a consortium. Right? And sometimes we get individual feedback from counties, and this time it's individual feedback from counties that are saying, this is gonna hurt us. It's gonna tear down the system, and it's gonna make things harder with a program that was, showing that the program actually works and that there's a human touch to it that fills a gap that, you know, will go unmet, really, if the programs are unfunded. So I just hope as we move into May revise that that those pieces will be taken into consideration.
I would also say it's one of the most unpopular I'll reiterate it because I said it already. Unpopular, pieces in terms of member feedback and, members who are frustrated by the proposal as it stands. With that, we'll move to public comment if there's any public comment either on the 988 or on mobile crisis. And if you could state your, name, your organization, and your position in thirty seconds or less.
Speaker 24
Good afternoon, chair and members. Diana Luna with the County Behavioral Health Directors Association and also on behalf of the EMS Administrators Association and the League of California Cities. First, I'd like to thank the subcommittee for the panel and thoughtful remarks on the mobile crisis proposal. We join a coalition of 53 organizations as outlined in our coalition letter in strong opposition to the elimination of the statewide mobile crisis benefit. We have heard from multiple counties throughout the state that if enacted, this proposal would force them to either eliminate the mobile crisis benefit entirely or scale back hours and availability.
We respectfully urge the legislature to reject this proposal and maintain state funding to ensure that all Californians have access to an equitable and timely behavioral health crisis system.
Speaker 25
Good evening, chair member. George Cruz on behalf of the California Behavioral Health Association. We just wanna echo the concerns on mobile crisis becoming an an optional service for counties as well as supporting the budget request from the nine a call centers for a 105,000,000 for sustainability. Thank you so much.
Speaker 26
Good evening, chair members. Adrienne Shilton representing the California Alliance of Child and Family Services, and we represent nonprofit community based organizations across the state serving children, youth, and families. We also represent many mobile crisis response providers, including Pacific Clinics who you heard from today. And we also stand in firm opposition to the proposal to change the Medi Cal benefit to an optional benefit for mobile crisis. These programs are highly effective as as you've heard and and really save lives.
And we also stand in strong support of the increased investment for the nine eight eight call centers. This is a critical component of the three legged stool that we have in our state to respond as well to crisis calls. Thank you. Thank you.
Speaker 15
Oh, thank you. Jenny Biardo, executive officer of the California Behavioral Health Planning Council. We are a majority consumer and family member advisory body with state and federal mandates to advocate for people with serious mental illness. And we we urge you to reject the proposal to eliminate the statewide Medi Cal mobile crisis benefit. Mobile crisis teams are a proven essential part of our crisis continuum of care, and the services provided reduce unnecessary hospitalization, fifty one fifty psychiatric holds, and law enforcement involvement.
Making the benefit optional could force counties to eliminate these services. Thanks. Thank you.
Speaker 12
Danny Offer with National Alliance on Mental Illness, also known as NAMI California. We are the family members of people with serious mental illness, and we are very opposed to the governor's proposal to make this a a national benefit. Thanks very much.
Speaker 8
Hello. My name is Aston Giorgio Williams. I'm here with the California LGBTQ Health and Human Services Network. We urge the legislature to maintain the statewide mobile crisis benefit. Thank you.
Hi. Christy Gonzalez with WealthSpace Health. We provide nine eight eight services for 30 counties in Northern California here in support of the trailer bill language for AB nine eight eight and drawing your attention to a letter dated April 17 that the nine eight eight California Consortium sent asking for consultation for expenditure and fiscal finance projection the same way that CBHDA is included in projection for BHSA. Thank you.
Speaker 27
Thank you, madam chair. Brenda McCarthy with CSAC in opposition to this administration proposal. Counties are facing relatively flat realignment funding, changes in how the BHA, BHSA funds are are allocated away from services, and enormous cost pressures because of HR one, all of which will make it very difficult for counties across the state to continue to provide this essential service. Thank you.
Speaker 2
Good evening, madam chair. Mike Sherif with Fanslaw Government Affairs on behalf of the Steinberg Institute. The Steinberg Institute strongly poses a proposal to make mobile crisis benefit optional. Making this optional creates a patchwork system where access to care depends on your ZIP code and undermines the very crisis continuum the state has worked to build. We urge you to to reject this proposal and protect the statewide mobile crisis system.
Speaker 28
Good evening, madam chair and committee members. I'm commenting on agenda item DHCS number four two four two six zero. I am Cece the text line manager with Crisis Support Services of Alameda County. We should all be concerned about the 40% in state answer rate of Chatham texts in the state of California. Approximately half of those are being used by youth, and this service has a higher risk of suicide risk.
We urge you to make this important investment to forth so that our youth are able to get the care that they need in their moment of need. Thank you.
Speaker 29
Good evening. My name is Christiana Bosch Gazal. I'm with Bucklew Programs nine eighty eight call center. Our account our call center serves Marin, Sonoma, Lake, and Mendocino Counties. Over the last year, our center has seen a 70% increase in call volume compared to this time last year.
Yet, our budget remained flat since the previous fiscal year. Our staff are working hard to meet this rising need, but without corresponding funding, it becomes increasingly difficult to maintain the level of care our community deserves. Thank you for your time and consideration.
Speaker 30
Good evening, everyone. My name is Connie Mann, and I'm with Bucklew Programs. Thank you. And I'm also here to comment on DHCS agenda item forty two sixty. Our agency provides nine eight eight services to four counties.
And considering the lifesaving impact of nine eight eight, This is a priority population, and it is imperative to ensure the nine eight eight system in California has the capacity to respond to all contacts. Thank you for your consideration.
Speaker 18
Good evening, chair and member. My name is Trent Murphy. I'm with the California Association of Alcohol and Drug Program Executives, also known as CAPP. We represent over 450 treatment sites across the state. We just wanna like to oppose the mobile crisis benefit being optional.
We'd also like to reiterate NARGIS with the consortiums and their proposal for the $105,000,000 for the ninety day call centers. Thank you.
Speaker 31
Adam chair and members, my name is Van Hedwall, OMFT. I'm the director of San Francisco Suicide Prevention, Felton Institute. Again, agenda item four two six zero. I'd like to comment on our agency provides services to San Francisco and San Mateo Counties. We urge this subcommittee to protect the integrity of the nine eight eight surcharge, clarify that DHCS should lead the funding methodology based on clinical need and ensure these funds stay dedicated to center operations indefinitely.
Thank you so much.
Speaker 32
Good evening, madam chair and members. My name is Andrew Jayarukherme with Alpha with San Francisco Suicide Prevention to comment on the agenda four two six zero. Our agency provides services for San Francisco County. We're a member of the San Francisco of the California Consortium. Today, we're asking you to ensure that our budget request to ensure all Californians in crisis have access to timely care that they need.
Not all centers are currently able to provide twenty four seven text and chat services for and our colleagues are eager to expand their capacity to provide much needed support and connection and care for our community.
Speaker 1
Thank you so much. With that, we're gonna move on to issue four, which covers the administration's Behavioral Health Services Act Revenue and Stability Trailer Bill and the proposed updates to substance use disorder treatment standards. We're going to hear from DHCS Department of Health Care Services, the LAO, our legislative analyst office, and the County Behavioral Health Directors Association. And, you're welcome to I don't know if LAO you're welcome to stay there or come down wherever you wherever you feel like being. But we'll, start with DHCS, then go to LAO, and then go to executive director Cabrera of the County Behavioral Health Directors Association.
Speaker 13
Great. I can begin. I'm Marlyse Perez with the Department of Health Care Services. And I'll just give you a very brief overview of the trailer bill for the BHSA revenue and stability. So basically, this trailer bill, was required in the implementation of BHSA.
We were required to have a revenue and stability work group to assess the year over year fluctuations in tax revenues, generated by BHSA, and this was to help with some short and long term fiscal stability. And so the trailer bill would amend the maximum prudent reserve levels and also impose a minimum expenditure requirements on the counties. So through the work group, recommendations were brought forward. This is how the trailer bill was established. And I'll just touch very quickly on, why this proposal is really set to reduce volatility.
So part of the proposal is to reduce prudent reserve levels, and this is really to ensure then that more funds can remain available for counties to spend on programs and services. There is historically, counties have built up significant prudent reserves, but they did not draw from them during economic downturns. As one example was during COVID, less than five counties actually accessed prudent reserves. But also, just one thing to touch on really quickly is, the counties also have, we are not changing the reversion period, and counties still have a large amount of unspent funds available that they can expend outside of just the prudent reserves. Most counties do not spend the allocation they receive that year.
It's traditionally spent more in the second year or remaining years for our small counties that have up to five years. So I'll just pause there. And if you have any questions, happy to respond to those.
Speaker 1
Thank you. We'll move to Elio and then director Cabrera, about four questions.
Speaker 33
Yes. Will Owens with the legislative analyst office. So we were asked to briefly cover some of the context around the volatility of the revenue source as well as the trailer bill. So as the legislature considered the governor's proposed changes to the MHSA a couple years ago, which eventually became the BHSA, our office was asked to evaluate some of those impacts. And one of the analysis we did was on the revenue volatility of the underlying tax and the governor's proposal, how it would impact that.
A few key findings from the analysis. So first, just to highlight the volatility, the BHSA millionaires tax is about three times more volatile than the state's general fund revenues broadly. Second, so around the specific proposal for reserves, a little context. So reserves are obviously a key way for counties to manage some of this volatility. This is important in a couple of ways.
First, in times of lower revenue, it allows counties to draw on these reserves to maintain ongoing program expenditure levels without having to reduce programs. The second is in times where revenues are higher, it allows the counties to set aside some of these revenues for future downturns and also not to grow this ongoing spending to a level that would not be sustained given the high volatility of the revenue. Lastly, so we found that absent changes that directly address this volatility in the revenue, that prior to BHSA, the previous levels of reserves were unlikely to cover revenue down declines that could be expected to occur from time to time during typical economic times, let alone during an economic recession. So the final BHA, as you heard, included language to set up this revenue stability work group to address the volatility, as well as the BHA itself slightly lowered the reserves from what they originally were. So the trailer bill mostly enacts the recommendations put forward by the revenue stability work group in their final report.
One of the changes, as you heard, was reducing the reserves. Another one I want to highlight is the setting of minimum expenditure levels. So what this new policy would do is somewhat smooth out kind of the program expenditures that counties would expect and plan to make over the course of their three year integrated plan period, allowing for at least somewhat more consistent program planning and funding levels. The administration has put forward that this kind of smoothing out of the expenditure levels is part of the reason that reserves can be lowered from what they currently are, and therefore proposes to lower them. So the recommendations and subsequently the proposed trailer bill do make progress towards the goals set forward in the act around addressing some of the underlying volatility and issues there.
That being said, there are some issues that legislature may wish to consider. So first, the legislature could request additional information from the administration on whether the reduction in volatility from the minimum expenditure levels is sufficient to justify further reductions in the prudent reserve levels. The second is the trailer bill actually does not specify the methodology the department would use to determine the minimum expenditure levels. Our understanding is they'll use the methodology that's found within the report. And while we have not raised necessarily issues specifically with that, we would note that the current language limits legislative oversight of changes in that methodology moving forward.
The legislature may consider requiring something like a thirty day notice period prior to any type of methodology change to to ensure legislative oversight. Happy to answer any questions.
Speaker 6
so much. Michelle Cabrera with the County Behavioral Health Directors Association. And Madam Chair and members, was also a member of the Revenue Stability Workgroup from a couple of years ago. County Behavioral Health Directors actually initiated the conversation with the state about the revenue volatility and the need to stabilize it, during the negotiations and discussions around BHSA legislation. In particular, our members wanted to ensure that as a third of the millionaires tax funding was shifted away from mental health services to pay for housing and subsidies for housing, we wanted to make sure that those changes and as well as the new programmatic requirements were predictably planned around and that we could deliver on the promise of the BHSA.
As referenced by the LAO, the millionaires tax is likely one of the most, if not the most, volatile funding source that we receive as a state because it is very difficult to plan and predict how millionaires will fare in terms of their earnings and investments. And yet, it is also the largest source of non federal funding that we receive as county behavioral health. It accounts for a third of our overall funding. And I think what's not as well known is how this functions. It is currently leveraged.
Roughly one half of the millionaires tax is leveraged as a source of nonfederal share for Medi Cal services. So we are expected to manage our entitlement with what we call in health care terms sometimes a global budget. We get lump sum funding from the state in the form of sales tax, vehicle license fee, and the millionaires tax, and then we use that to draw down federal funding for the most part. Fun fact, the way that we determine how much money we will have for our three year spending plans under the BHSA is we, CBHDA, a nonprofit trade association working for county behavioral health directors, have a fiscal consultant who looks at what the Department of Finance projections are for the economy as a whole, and then he gives us a guesstimate, a very educated one, but a guesstimate about what those fiscal outlook, what the fiscal outlook will be. And we build our plan around that.
Then the state controller gives us a monthly drip, so what the state estimates for that year it will be, and two years later there's a true up, positive or negative, based on what receipts actually were. There had been a conversation for quite some time about this expectation that counties spend down all the money in year one. I lay all of this technical information out so that you can understand it be actually impossible to even know how much money is in year one, let alone plan around it and spend it. The fact that counties have had such a minimal amount of MHSA historically reverted, meaning it wasn't spent within the three year plan, shows just how creative we've gotten in trying to draw that money down. Today, a lot of counties are budgeting well over what they anticipate they'll get so that there's not this perception of unspent BHSA.
But in times like this, with the threats of HR one or the possibility of lost funding for mobile crisis services or increased demand and pressures on our system, that is a very risky proposition for a county behavioral health director. So the proposal put forward by the state was really a modification of what we had suggested. We said you could create a rolling average and look back. Now, our look back, I shared a document that shows the trend lines, the current MHSA volatility versus what the state's proposed three year rolling average would look like versus what the five year rolling average would look like, And you can see that the ability to manage the fund source at a net positive is much smoother on the five year rolling average. The state has argued the need to go to a three year so that we're closer in time to where the fund source actually is.
However, you will also note on the version of the chart that includes the numbers at the bottom that in years where the millionaires tax dips significantly, counties are in the negative within the three year rolling average to the tune of sometimes 15% or more. So imagine a scenario where we're limited, the prudent reserve level drops to 10%, but then our revenue stream goes negative 15%, and maybe it was positive 30% the year before, we will still be on Toad's wild ride. And we do not want that. We don't think that it's good when you're tying this funding source and a third is set aside to pay for people's housing. We need housing to be stable, but frankly, we also need our providers to feel secure in their relationship with us, and like we're not going to be taking them on those peaks and valleys moving forward.
So we respectfully urge the legislature to work with us to amend the proposed trailer bill, maintaining at the very least the prudent reserve level where it's at currently. That's just good fiscal management, especially when you're working as a health plan. All health plans need to be able to manage risk very carefully. Thank you.
Speaker 1
Thank you. Any questions? Any questions? No. I, it seems to me I don't wanna negotiate this thing right here, but it seems to me that that, there's two different viewpoints and there is a place to meet in the middle, and that this does need a little bit more work.
I think there's differing views around reserves. And anytime you have too many reserves, people are upset because you're not spending them on people. And when you have too little reserves, it's a huge worry because you're not gonna have money to spend them on people. And it seems like it just seems to me there's somewhere to meet in the middle on this, and there could be, more work going into May revise on, how to get this right. I've also heard concerns about what the work group really was, how many times it met, if it really was robust, the kind of input that was taken, and, that, you know, maybe there wasn't enough going into this work group or it wasn't a robust enough work group.
And then looking at the chart, the data seems to really show, you know, you can use diff you can use these averages and get all kinds of different numbers. But over time, the more you stretch things out over time, the more you can see the real trends and where you need to be. So I just would urge another look at what you're using to calculate the minimum expenditure levels. I don't have a ton of questions on this, but there is another presentation about updates to the substance use disorder treatment standards in that trailer bill. So we'll move to that real quick.
Speaker 20
I can take that one. Thank you. So, DHCS is proposing this additional trailer bill to align evidence based standards for substance use disorder treatment so that we can, in fact, align our state standards for substance use or SUD treatment facilities that are licensed or certified by the Department with current evidence based standards of care. Existing law already requires DHCS to adopt American Society of Addiction Medicine or ASAM criteria or equivalent evidence based standards as the minimum standard of care for the facilities that we license. And ASAM standards are periodically updated to reflect the current evidence base and consensus in the field.
So at the 2023, ASAM replaced their third edition standards with the fourth edition, and in this TBL we are proposing to update facility licensure and certification guidance to align with ASAM fourth edition standards. And the key change we're proposing is to eliminate a licensure category that is no longer supported by clinical evidence or recognized by ASAM. So specifically, our current licensure law permits us to license residential treatment facilities to provide detoxification only ASAM's fourth edition standards do not recognize detoxification as a standalone residential level of care, and ASAM no longer even recognizes detoxification as clinically appropriate terminology at all. Detoxification services have been referred to for several years as withdrawal management care, and withdrawal management is meant to be integrated within a broader continuum of residential treatment, so that it not only focuses on the physiological and psychological features of withdrawal, but also addresses the underlying substance use disorder and moves people as seamlessly as possible into treatment and recovery care. Consequently, we're proposing to eliminate the detoxification only residential licensure category as of 06/30/2027.
By that date, holders of detoxification only licenses, their licenses will expire and facilities must transition to provide integrated recovery treatment and or withdrawal management services. This would specifically impact six SUD treatment facilities among more than 1,000 facilities that are currently licensed by DHCS. We have six that currently hold detoxification only licenses, and we are advancing the trailer bill now with a one year timeframe before the change takes effect so that we can work with facilities over the next year and support them in transitioning to a licensure type that aligns with the new standards. So the other thing that you'll see in the TBL is modernization of terms in state law where we are replacing the references to detoxification with withdrawal management in several sections of statute that govern our certification of alcohol and drug programs and also our narcotic treatment program licensure. So really the goal of this is to avoid cost inefficiency.
We don't need continued state resources going into licensing a category that isn't recognized as the current standard of care, and notably our laws for payers are aligned, so both commercial health plans and our drug Medi Cal, drug Medi Cal organized delivery systems are meant to follow ASAM standards in their level of care and coverage decision making. This level of detoxification only services going forward will also be something that payers will not cover. We think it is the responsible thing to do to update the standards and implement the fourth edition. Thank you.
Speaker 1
Thank you so much. I realized I had one other comment, but it's back to the, previous issue that anything that's gonna limit the legislature's oversight is gonna be problematic. So, going back to the first topic of this panel, I think it's worth another look at that trailer, trailer bill and really considering how you might revise that to not to and not adjust any oversight by the legislature. Certainly, that's something that we would not be satisfied with when it comes to the the Behavioral Health Services Act revenue and stability trailer bill, just to clarify. As it's getting late, we both know, getting my thoughts out clearly for you, but it it's problematic to hear that the legislature's oversight would be clipped back within the, trailer bill that you've proposed.
Speaker 13
Yeah. We definitely can look at that. And just to be clear, the reason we didn't put the formula within the trailer bills, we didn't wanna limit it if we needed to bring the work group back together. We did put the, for the three year weighted trailing average, the percentages that we were going to utilize, but that was the work group's recommendation of, like, we don't wanna lock that further into legislation if we need to bring folks back together. And as was mentioned, this has been very volatile, and this was the solution.
We went through many different drills and runs. I know CBHDA provided one. We, the work group, hired an economist. We have a lot of detailed information that we've looked at, but by no means was any limitations by the legislature in intent of that. So we'll definitely review that.
And we did have robust meetings. We had over a 150 participants. So there was active engagement in this process in the work group. So I just wanted to speak to that as well. Don't want you to think we just did this on the side.
We've been very collaborative under BHSA and with all of the required partners and our provider partners and others as well.
Speaker 1
I appreciate that. And I know you know probably better than anybody how controversial it was to move these dollars around, how much concern the public has had about that. It was very, very narrowly passed by the voters, and I think there's a lot of concern about where the money is gonna go and how it's gonna be allocated. And so we just urge that, you know, you share that information with us, that you take another look at the language, make sure the legislature's oversight is fully maintained, with that. And I don't have any other questions, on, on the substance use disorder treatment standards.
But thank you for your presentation. We'll open it up to public comment if there's any for issue number four. If you could state your name, your organization, your position on the issue in thirty seconds or less, we would be grateful.
Speaker 27
Thank you, madam chair. Brenda McCarthy with CSEC, also for the urban counties of California and the rural county representatives of California concerned about the trailer bill that, as drafted by the administration, would reduce the ability of counties to manage the inherent volatility of these revenues. Your agenda lays out the the amendments that counties are asking for, so I won't go through those, but just appreciate your comments about finding language that helps counties manage the volatility while also providing the essential services. Thank
Speaker 1
you. Thank you. Seeing no other public comment, we're gonna move to issue five, and we've got director Stephanie Clendenen from the Department of State Hospital's leadership team to provide an overview of the 2627 budget estimates, budget change proposals, and April finance letter requests. And if you're able to do all that in five minutes or less, then we will be grateful to you. We will be grateful.
Speaker 1
But welcome. Welcome. I know you have important things to say, and we don't wanna, cut you off. Over here. Right there.
Speaker 34
When you're ready, please. Good evening. I'm Stephanie Clendenin, director for the Department of State Hospitals. And I'm joined by Chris Edens, who is our chief deputy director of program services Mark Beckley, who's our chief deputy director of operations and Brandon Price, who's our chief of hospital services. I'm gonna start off and provide a brief overview of the department and its budget.
And in the interest of time, our plan was just to present those caseload estimates that had either savings or requests for resources, and then move into right into our the proposals and the COBCPs and April 1 item. But happy we can stop if you have questions along the way, if that works for you. The Department of State Hospitals manages the California State Hospital System. Our mission is to provide evaluation and treatment in a safe and responsible manner by leading innovation and excellence across a continuum of care and settings. We operate five state hospitals located throughout California with inpatient beds at the intermediate, acute, and skilled nursing facility levels.
And we have a conditional release program, which is a system of community based services operated in partnership with county behavioral health departments and private providers that is designed to transition patients back into the community following a forensic commitment to the department. And we also have partnerships with county behavioral health programs, private providers, and county sheriffs to provide community based restoration, diversion opportunities, and jail based treatment programs for individuals committed to the department as incompetent to stand trial. The individuals served by our system of care are mandated for mental health treatment by either a criminal or civil court judge or the board of parole hearings. We serve individuals committed to the department as incompetent to stand trial, not guilty by reason of insanity, offenders with mental health disorders, sexually violent predators. We also serve, incarcerated persons from the California Department of Corrections who need inpatient mental mental health services.
And lastly, we serve individuals conserved by a civil court under the Lanterman Petra Short Act. With respect to the department's budget, we pro the proposed budget for fiscal year twenty six twenty seven totals 33,200,000,000, including state operations and capital outlay and represents a decrease of, 34,100,000 or 1% from the 2025 budget act. As it relates to our caseload estimates, the department is projecting the census of 8,317 by the end of the fiscal year and 8,427 across its programs by the end of fiscal year twenty six-twenty seven. The increase is primarily related to expected increases in community based restoration and diversion placements for individuals deemed incompetent to stand trial. Moving on to the specific caseload estimates for the patient driven OE and E item, the Budget Act of 2019 adopted a standardized methodology to provide funding for patient related OE and E items based on updated census estimates for each fiscal year and an estimated per patient cost derived from past year actual expenditures.
Due to rising costs, the department requests 19,000,000 in 'twenty five-'twenty six and nineteen point six million twenty six twenty seven and ongoing for increases in costs for utilities, pharmaceuticals, foodstuffs, and outside hospitalization. For the incompetent to stand trial solutions, as of governor's budget, the department projects a onetime savings of 114,000,000 in 2324, 117,800,000 in current year, and 94,200,000 in budget year. The 2324 projected savings is related to counties who have not yet progressed with their IST infrastructure project, and the department proposes to revert any unobligated funding in this program. This funding was originally appropriated in 2324 with five year encumbrance authority to provide grants to counties to develop additional housing to support incompetent to stand trial individuals receiving services through diversion and community based restoration. The projected current year and budget year savings are primarily a result of updated phase in activations of DSH diversion community based restoration programs and programs serving lower census levels than the maximum budget the program is projected to support.
With respect to our lawsuit, I did wanna provide just a really brief update. This is the lawsuit that was focused on the time that IST defendants were waiting in jail to be transferred to, DSH treatment programs. The court ordered that the department initiate substantive treatment services within twenty four, days for IST defendants and gave us a series of benchmarks for us to meet with the ultimate goal to meet, achieving twenty eight days by 03/01/2025. As a result of the rapid implementation of IST solutions, easing of the pandemic impacts of the, on our DSH facilities, and other efforts by the department, the department has seen substantial decrease in both the IST waitlist and wait times and met all of the court ordered benchmarks, and the counties and then continues to provide timely access to services for individuals bound incompetent stand trial within twenty eight days. And just to provide a measure of that progress, during the pandemic in January 2022, we had reached an all time high of nineteen fifty three IST individuals on the pending placement lists, with individuals averaging over one hundred and forty days to treatment.
At the April, we had just two fifty individuals on the pending placement list. Two fifty individuals represent significantly less than just one month's worth of referrals, as this fiscal year we're receiving an average of four zero five per month, and the average time to initiating treatment for IST individuals, in March was just around five days. So I'm now gonna turn it to it over to chief deputy director Edens to cover our ConRev non SVP estimate and transitional housing BCP.
Speaker 35
Good evening, chair. Chris Edens, chief deputy director for program services. We'll start off with the, conditional release program, non SVPs. The department is proposing 2,100,000 in budget year and ongoing in response to cost increases to maintain program operations at our Golden Legacy Step Down program. Of this amount, 1,800,000 supports base rate increases governed by the Department of Health Care Services, including the IMD rate and the quality assurance, fee rate.
In addition to these base rate increases, 300,000 will be used to support essential psychiatry services required to meet program standards. In addition, the department has realized one time current year savings of 4,500,000 resulting from the closure of the ConREP FACT regional program here in Sacramento and the delayed activation of the new Central California FACT program that will eventually replace what we've lost here in Sacramento. We are proposing to redirect these savings, one time savings to support 1,600,000 in current year costs related to the increased bed rates at our Golden Legacy program and apply the remaining 2,900,000 to offset overall ConRent provider increases. Moving on to, with regard to the Senate Bill three eighty transitional housing report BCP, the department is proposing 469,000 in the budget year to support two one year limited term positions to implement s b three eighty, which requires the department to conduct a feasibility analysis on the establishment of transitional housing facilities for the ConREP SVP program and to submit a report to the legislature on our findings of the analysis by 01/01/2027. The resources requested are are needed to complete extensive research and analysis of transitional housing models and laws in other states, including, as well as including operational expense funding to support travel to visit a few of these programs and to consult with subject matter experts.
That concludes my testimony. I'm gonna hand it over to, chief of hospital services, Brandon Price.
Speaker 9
Good evening. Brandon Price, chief of hospital services. DSH requests three point nine million and four permanent positions in fiscal year twenty six twenty seven and 1 point 1,000,000 in fiscal year twenty seven twenty eight and ongoing to support dental services provided to patients at Department of State Hospitals Metropolitan and Patton. This proposal includes funding for one trailer to serve as an expanded dental clinic at DSH Patton as the existing dental clinic cannot accommodate the additional resources. The four positions requested are three dental hygienists, one dentist, to provide adequate staffing levels to meet patient dental care needs and align resources at DSH Metropolitan and DSH Patton with that of the other state hospitals.
Patients residing in state hospitals often exhibit complex medical, psychiatric, and cognitive conditions that place them in elevated risk for poor oral health outcomes. The increased hygienists will focus on preventative care, allowing dentists to prioritize urgent and restorative care and examinations. Thank you. I'll turn it over to Mark Beckley.
Speaker 36
Great. Good evening. Mark Beckley, chief deputy director for operations. I will be presenting, two of our infrastructure, budget change proposals as well as two budget bill items we have proposed. For infrastructure projects, we have two electrical infrastructure project upgrades at our hospitals, DSH NAPA and DSH Patton.
For NAPA, we proposed 7,270,000 in general fund for the working drawings phase of their electrical infrastructure upgrade project. The project will upgrade the electrical distribution infrastructure with a 2.4 kilovolt to a 12 kilovolt distribution system and includes replacement of the existing PG and E transformers, substation, utility feeder lines, facility transformers, switch gear, and installation of new generators. For patent, we proposed 1,760,000 in general fund for the preliminary phase plans phase to provide upgrades to DSH patent's electrical infrastructure. This project has two separate phases. The first phase is to upgrade medium and high voltage elements within the infrastructure, and the second phase is to upgrade low voltage electrical distribution at each building by replacing old panels and wiring.
The electrical infrastructure for both of these hospitals were installed in the nineteen seventies, so over 50 years old. And the systems are reaching end of their useful life. These projects are necessary to ensure resilient and reliable primary and backup electrical flow to our facilities to support critical HVAC lighting, alarm systems, and medical equipment to protect the health and safety of our hospital team members and patients. I'll now move on to our budget bill language proposals. The first item is for funding transfer authority.
This language provides DSH with the ability to transfer resources across hospital programs between DSH Sacramento and the hospitals. This authority would enable the hospitals to quickly move money from programs that have one time savings to address areas of urgent urgent need in another program that may impact patient care, health and safety of DSH patients and team members and visitors. Areas of need could include urgently needed emergency repairs due to electrical and HVAC system failures, due to wind and high heat events, damages to hospital grounds and buildings due to heavy rains and flooding, and the need to replace critical medical equipment such as med carts, beds, panoramic machines, and repairs to facilities, equipment such as transportation, vehicles, boilers, and chillers. The second item is to extend the encumbrance time frame for our anti ligature risk projects. And this is really just a technical change to allow us one additional year to uncover those funds.
And we're happy to take any questions you might have.
Speaker 1
Great. Thank you. Anything from DOF, Raleo? No. I don't have any questions.
Do no. I just wanna, I just wanna well, actually, I do have one question. Did you say you're down to five days now with
Speaker 1
Yeah. I just wanted to, compliment you really and say what a pleasure. I know you and I talked about this last year. There was progress being made, and I think this is exactly the kind of progress taxpayers wanna see when the legislature puts policy in place, puts money behind something, that we get the kind of results that you're showing, which is which is true progress with this with a very, very difficult population and a very difficult situation. So, just a thank you for me on that.
Thank you. Yeah. With that, we'll move to a public comment on, issue five. Anything on, budget at Department of State Hospitals? Seeing no public comment on this, we're gonna move to our last issue of the evening, you know, and say thank you to our panelists.
Innovation partnership fund and mental health wellness Act. So we will welcome executive director Grealish of the Commission on Behavioral Health. The commission is going to provide updates on two programs, the Innovation Partnership Fund and the Mental Health and Wellness Act grant program. And you're welcome to start whenever you're ready. And if you're able to do five minutes for us, that would be wonderful.
Speaker 37
I'm happy to try to bring that in for a landing. So Brenda Greilich, executive director for the Commission for Behavioral Health, Thank you so much for having us here this evening to talk to you a little bit about the Commission for Behavioral Health and some of the major projects that we're we're we've been working on. So we're an independent state agency led by 27 commissioners. And so by statute, our membership reflects the breadth of the public behavioral health system, including consumers, providers, family members, community members, and other state partners. And this structure is intentional.
So we're designed to surface challenges and solutions from multiple angles with the consistent focus on accountability and outcomes for Californians most affected by the public behavioral health system. Our primary tools are data and policy research, program evaluation, grant making, and technical assistance, and public transparency. We publish policy reports that combine data analysis with stakeholder input to identify what is working, what is not, and what practices can improve statewide outcomes. We also evaluate programs so California can learn from implementation, improve performance over time, and clearly understand results from public investments. A key part of our transparency work is our public facing data tools, so like our commission commission transparency suite, which makes behavioral health data accessible to the public and decision makers.
On the grant making side, we fund and support local programs and partnerships across the age and care continuum, often pairing grants with technical assistance and expectations for collaboration. We're looking to help reduce silos between counties, providers, and other community partners. And we also maintain an emphasis on historically underserved communities through our community empowerment and advocacy contracts, which are designed to strengthen participation and ensure local planning reflects community needs. So under the Behavioral Health Services Act, the commission's role is evolving in several important ways. First week are continuing our responsibilities throughout the transition, with the county innovation funds that can still be encumbered through June 2026, And so we're actively working with counties to encourage, try timely and strategic use of those funds.
Second of all, we're, pivoting, to implement innovation at the state level through our innovation our brand new innovation partnership fund grant program, which provides a maximum of $20,000,000 annually for five years to support innovative efforts that advance statewide transformation. And I'll speak to that in a moment. And third, we are continuing our major initiatives, including the Mental Health Wellness Act, the Behavioral Health Student Services Act, our obligations for our full service partnerships evaluation and reporting, and like I just mentioned, our advocacy contracts with nine underserved populations. So in addition to expanding our membership from 16 to 27 members, we've expanded our expertise to include lived experience and system expertise for both mental health and substance use disorders. We've been working on a strategic plan update.
So we have a current strategic plan, and we're looking to kind of put that strategic plan through the lens of the Behavioral Health Services Act. And thus far, through that work, we're centering on four priorities, and that's to focus on individuals who have the highest behavioral health needs, ensuring substance use disorder integration in our portfolio projects, expanding peer services and peer led models, and then building the evidence base for those innovations like Reg just mentioned. And so with regard to the innovation partnership fund, innovation, like I mentioned, is moving from the county to the state level, and that's going to allow California to identify what works, really help us build a stronger evidence base, and move effective models beyond single county pilots so that we can test models with rigor, make sure that there's evaluation happening, and that this can be scaled across the state and across different regions. So through to develop the innovation partnership fund, we really focused quite a bit in 2025, holding extensive listening sessions with our community members, providers, counties, and state partners. That resulted in our innovation partnership framework, which led to our request for application that was published on March 20.
As mentioned in the background materials, we've got two distinct grant categories, one for small and one for large grants. We're looking to define innovation as a new or adapted or expanded approach to solving problems in our behavioral health system. We've got a definition for innovation that's in our our application that again was developed with our commissioners and our community members. And again, really at its core, our innovation is looking to transform how care is delivered, and we're really looking to focus that on ensuring that there's impact and that there's equity and that services are provided with dignity. So we've had quite a bit of interest in our innovation partnership funds.
So since that March 20 release, we had to hold two bidders conferences because we had over a thousand people who wanted to participate in our in our bidders conference. We're expecting quite a robust pool of applications that are due this Friday, May 8, And we're looking to put awards out in mid June so that we can begin implementation so that our implementation of the Innovation Partnership Fund would coincide with the implementation of the BHSA on July 1. So moving to the Mental Health Wellness Act, we've got our ongoing $20,000,000, six priorities for the Mental Health Wellness Act. Again, these are our crisis continuum funds that are really focused on prevention, early intervention, and crisis response. To date, we've got our EMPATH units, which are psychiatric emergency units and department our departments in hospitals, behavioral health supports for older adults through AgeWise and PEARLS programs, a substance use disorder medication assisted treatment expansion.
We have our maternal mental health zero to five collaboration, performance management for full service partnerships, and that's using data for continuous quality improvement. And then we're getting ready to prepare for our peer respite RFA that we'll be putting out soon. So really looking to to lean in on peer respites as alternatives to higher levels of care. I do want to say that we're grateful that the commission was able to preserve the Mental Health Wellness Acts after last year's potential budget cuts and appreciate the strong support that we received from legislators and our stakeholders that made it possible to keep serving communities across California. And with that, I think I'll go ahead and stop there because I know it's been a long night for everybody, but happy to answer any questions.
Speaker 1
Thank you. Anything from d f l e o? No? Any questions, assembly member? Looks like none.
I don't have it. I know. We're all so tired. Oh, go ahead, please.
Speaker 7
I don't really have a question, but thank you for your presentation. Just in terms of the substance use disorder pilot program, I would like to know more information about that. And I know it's mentioned evidence based medications for addiction treatment and whether or not any of the pilot program involves abstinence based recovery, like 12 step programs, or if it's just the MAT, which I I believe in all of it. But I was just wondering if the pilot program involves any type of 12 step abstinence based recovery too.
Speaker 1
Thank you. I don't have any, questions either. So but I wanna thank you for your presentation and, open it up to see if there's any public comment, which I don't think there is. Seeing no public comment for this issue, we'll take public comment for items, not on the agenda, which I don't see either. So with that, we're gonna say thank you to all of our witnesses, panelists, staff, members of the public, and legislators who stayed so late tonight.
And we're now adjourned.
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