Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services
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Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services California State Senate
Follow its sittingsSpeaker 2
The average time to initiating treatment for our IST individuals in March was around five days. With respect to the impacts of SB1323 and Prop. 36, Prop. 36 provides for specified drug and retail crimes that previously were charged as misdemeanors to be charged as treatment mandated felonies or receive increased sentences. This increases the range of crimes for which someone may be found incompetent to stand trial on felony charges and referred to DSH programs for treatment.
Therefore, may increase referrals to DSH. However, the number of individuals referred to DSH for treatment may be offset by the application of SB1323. Don't really need to tell you, Chair, about this bill, but I will provide a little highlight on it. SB thirteen twenty three became effective 01/01/2025. It included amendments to modernize the IST process by providing judges the authority to determine if restoration of competency is in the interest of justice and if not, to provide longer term, more comprehensive treatment options with an emphasis on mental health diversion.
Under SB1323, when a court finds restoration is not in the interest of justice, the court must conduct an eligibility hearing within thirty days to determine if the individual is eligible for placement into a diversion program. And if not eligible to be granted a diversion, the court may consider referral to the public guardian for conservatorship investigation, assisted outpatient treatment, care court, or may reinstate competency proceedings. This provides an earlier pathway intended to divert eligible individuals into community based treatment when appropriate, rather than referring to inpatient restoration of competency treatment at DSH. So we continue to monitor our IST referral rates and the potential impact of both Proposition 36 and SB thirteen twenty three. But overall, to date, for fiscal year for this fiscal year, the department is experiencing a small reduction in referrals compared to last fiscal year.
During the first eight months of fiscal year 'twenty six-'twenty seven, we received an average of four zero five IST referrals per month compared to an average referral last year of four fifty one per month. So I'll now turn it over to Chief Deputy Director Edens to cover the remaining items.
Speaker 3
Morning. Chris Edens, Chief Deputy Director for Program Services at the department. I will be covering the conditional release, program non SVP, caseload item. The department proposes $2,100,000 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, which include the IMD rate and the quality assurance fee rate.
These rates both support the program's licensure. The rate increases, by 3.5% annually and covers basic expenses to operate in IMD and has not been updated within our DSH contract since 2022. In addition to these base rate increases, 300,000 will be used to support essential psychiatry services required to meet program standards. The current funding level for the contracted provider is insufficient to support a full time psychiatrist. And during a recent oversight visit, we identified that the provider was unable to meet our treatment standards due to the gap in the psychiatry coverage.
In addition, we have realized one time current year savings of $4,500,000 resulting from the closure of the ConREP FACT regional program here in Sacramento and the delayed activation of a new Central California FACT program that will replace our, program that we've lost here in Sacramento. But due to that delay, we are, proposing to redirect these savings one time to support $1,600,000 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, ConRep provider cost increases. That concludes that item, and I will move on to the question, the last question that's in the agenda, with regard to an implementation update on the new system for allocating beds to counties for the LPS and IST non restorable and maximum term populations. So, just by way of background, statutory authority allows the counties to contract with the Department of State Hospitals for the treatment of LPS patients. The department is one of the various treatment options available to counties for LPS patients.
We work with Cal Mesa, who collaborates with each county to develop negotiate an MOU, which governs the service of our LPS patients within the system. And this MOU also references the number of beds that are made available to counties as well as the bed rates that are charged. Prior to 07/01/2025, the total number of state hospital beds available to counties was 556. At that time, there was no set allocation per county, and LPS admission was offered essentially in first come, first referred basis. Counties then reimbursed the department for actual usage of a state hospital bed, based on our negotiated daily bed rate.
However, as of July 1 of the department as well as Cal Mesa collaborated with counties to transition to a new, county by county bed allocation model, which addresses several issues, that were raised with the former process. It allows counties to manage the utilization of their allocated beds and provides the opportunity to maximize the use of the state hospital LPS beds for those who are in need of the highest level of care. To support the counties with this transition, we established a centralized patient management team dedicated to this effort. We also implemented a SharePoint site that enables the county's real time information and access to their referrals, census, other tools and resources. We also standardized and streamlined forms to create efficiencies in the administrative process to help minimize, the number of unused bed days.
And also during the initial implementation of the new process, the department as well as Cal Mesa hosted regular open office hours to provide technical assistance to the counties. Overall, we've received a lot of positive feedback from the counties transitioning to the county bed allocation model. Last year, as I mentioned, historically, we had been making available a total of five fifty six beds. Last year, we increased this by 25. And more recently, in late January, early February, we increased the LPS capacity by an additional 44 beds.
And so we have been working with counties to try to fill those additional 44 beds. Pause there and see if there are any questions. Department
Speaker 1
of Finance, do you have anything to add? Will? Great. Thank you. Director, can we go back to on number three when you're explaining the just an update on the Prop 36 and SB thirteen twenty three.
Did you mention one of the last things you gave numbers on, like, the increase from 400 about four forty one per month in court referrals. Is that because of Prop 36? Is that why that's the increase?
Speaker 2
Actually, we've had reduction. Yes, and SB thirteen twenty three is winning out. So last year, we saw four fifty one referrals. And this year, we're seeing 400. Okay.
JULIET But is it just kind of like tearing out to
Speaker 1
a status quo because of Prop thirty six and thirteen twenty three? So as thirteen twenty three, the intent was to minimize, but not because of Prop 36. Is it fighting against that intent?
Speaker 2
I don't know that we see that. I think we are definitely seeing individuals going through the SB thirteen twenty three process. But we also, on the natural, see some counties increase over time. Are different things that happen that cause numbers to increase and fluctuate within counties. So overall, we definitely are seeing SB thirteen twenty three, place people going through the SB thirteen twenty three pathway.
But overall, we don't normally see a large number of those types of crimes within our commitment population, where that's the primary crime coming to DSH. So we're not necessarily seeing a significant increase in Prop 30
Speaker 1
Good to hear. Thank you so much. And then on the background you gave around the operating expenses, you mentioned the outside hospitalization for the patients. You talked about pharmaceuticals and just the increase. Can you share a little bit more and expand?
And I know we reached out to the department on this issue. And back in, I think it was like 2025, there's a report that anticipated the increase in expenses for outside hospitalization. But the current increase of about 22% exceeds the previous anticipation. What can be done in our control to minimize that huge increase in cost for outside hospitalization? Thank
Speaker 2
you for the question. Some of the cost increase is driven from not only inflation, but we also have an aging population within hospitals. And so that is partly what is driving as individuals age. There have increased costs for medical service and medical needs that are beyond the capabilities of what the department is licensed to provide. So definitely, we definitely have that challenge.
We also have, in recent years, implemented the health care provider network. So not only for hospitalizations, but we also do specialty medical care. We have to contract out for specialty services. So that is also included in those outside medical costs. So we are working with we contracted with a provider network to help us locate more to try to help us identify more providers that can provide services that might help increase competition for rates because it is difficult with our population to find providers that will serve our population.
And often, they want a higher rate in order to agree to serve our population.
Speaker 1
And I saw well, thank you for that. Outstanding utilization is the one that's dramatically increasing against everything else. Is there any preventative measures we can we can implement or turn to? Or is this just a matter outside of looking for more competition and so forth that I don't see I don't know how we get ahead of that. It's just gonna keep growing.
Speaker 2
It's it's very difficult with this population. They've had long term mental illness. They've had long term, often, institutionalization and, time in incarceration and have, which ages a population earlier than the normal population in the community. We often see the advanced illnesses earlier than you wouldn't necessarily see them in the general population. So it definitely is difficult with this population.
We certainly provide you know, we have an entire team of internal physicians that work on our teams, that are allocated out to the patients, that provide all the preventative maintenance services. But they generally have health care outcomes due to the long term mental illnesses.
Speaker 1
So is it actual treatments that state hospitals can't provide, or is it a type of license that is needed, a type of certain health care worker that is not in the
Speaker 2
Oh, yeah. So we are an acute psychiatric hospital. And so the model that we operate under is that we are an acute psychiatric hospital. People are inpatient to receive acute psychiatric services. While they're with us, we also provide dental care.
That will be a forthcoming item. We also provide medical care, but that's more like outpatient services. And then we provide specialty care. Just like you and I may go see our physician in the community, we have physicians that provide our general medical care. And then we may have to see a specialty provider for a certain ailment.
We also either have those specialty providers, or we'll contract out for them. Now, when somebody gets to the point where they need a surgery, or they have very significant medical needs that they need acute hospitalization for, that is beyond the level of services that we can provide. Our systems aren't designed. Our buildings aren't designed for that type of care. We don't have medical gases and those kind of things, anesthesiology, all of those things that you would need in order surgical rooms.
We just don't have all of that in our hospitals.
Speaker 1
And I recognize we can't bill to Medi Cal, but Medicare is eligible to cover these services. And these are aging population who are eligible for that. What is the percentage of our population that is getting this covered by Medicare?
Speaker 2
Thank you. We have about eighteen percent of our population that is covered by Medicare. The challenge, though, is that patients have the ability to decline. They have to be willing to sign up for Medicare, and we definitely provide that education. But we also have the challenge of a population that, particularly within our long term population, don't necessarily always see the benefit or understand the benefits due to their mental illness.
Speaker 1
Okay. And then talking about the IST solutions, you brought down all the savings since fiscal year 'twenty three, 'twenty four. Can you share maybe, Department of Finance, this question for you, how much we're proposing in the January budget to give in this category? And I should name the actual program. Yeah.
How much are we proposing for IST resources?
Speaker 2
Right. Nothing is requested. We are just reporting savings of $117,000,000 in current year, 94,200,000 in the budget year, and then we had 114,000,000
Speaker 1
from How much is left over? I guess maybe I should ask that. Is there any dollars left over in this fund?
Speaker 3
Yes. It's approximately just over $500,000,000 total for IS across our various IST solutions programs.
Speaker 1
Sir. Let me see if I understand. I know we've we're seeing savings from the past three years. Is that what you're referring to? That's going to be about $500,000,000 when you add them all up?
Is that what you're saying, Chief Deputy?
Speaker 3
Oh, I was referring to the available level of budget for It this fiscal does increase in the out years. We're only reporting onetime savings in the current year in the budget year.
Speaker 1
Okay. Thank you. And do we anticipate that being utilized at its full capacity this upcoming year, given the ongoing lack of usage?
Speaker 3
Yes. Yes, yes. So we've our savings are based on a review actual usage of contract. Some of the most of this is related to the community based restoration and the diversion programs that have since moved from our pilot phase to now our permanent programs. And, there's just been a slower ramp up for our counties to get to that maximum capacity of individuals served in the in the contracts.
Speaker 1
So the solutions the department and and department finance are proposing is at the max that we can that we anticipate not utilizing.
Speaker 1
And outside of the savings solutions proposed now, is there anything we're adjusting for better budget allocation under these programs? So we don't continue over budgeting? It seems like we continue over budgeting for this.
Speaker 2
Well, we're in a period of activation. So when we first requested the funding for IST solutions, it was based on an assumed rate of activation of beds and capacity across our community based restoration and diversion. That was, you know, back in 2022, and we were creating a whole series of new programs and with the best guess of assumption of when a county might be able to come on and ramp up. So, we've the dollar amounts that we have are what we need in order to, serve if each county that we're contracted with and each, community provider that we serve their maximum censuses, but we have been in a consistent state of activation, and we're still in that consistent activation state. I think next year, we're finally going to be, for the most part, with our community based restoration and diversion to the point where all the counties have activated their programs, And we'll start to see them, you know, and they're ramping up their censuses.
So we'll start to see a higher level of expenditure in these programs over time. But because we've been in that constant state there, at the beginning when we requested the funds, we assumed that they would come on at a certain period of time. And some of those things, due to, you know, things outside the department's control, may take longer for the county to ramp up their services.
Speaker 1
Because of the longer period to ramp up outside of our control, is that impacting any kind of service delivery? Is there a gap that has been created because of that? Or are people, like, on a waiting list waiting for these projects too?
Speaker 3
Yeah. I wouldn't say I mean, what our system looks like today is that most folks are going still through our competency restoration programs in an inpatient setting, so versus having, a broader number of, community based beds for diversion and community based restoration. So it really is more about there's a higher proportion of individuals going into the inpatient settings still. And our longer term goal, as you know, a part of IST Solutions really is to try to mitigate the risk of IST individuals coming back into the system. And that really is grounded in the philosophy around supporting diversion.
And so that is what we're really now working towards. So it's not a full gap. It's over time, we'll start moving more towards more individuals being served in the community.
Speaker 1
Okay. And then, Chief Deputy Director, on the the delay of activation on the new Central California facility, it's supposed to it was supposed to come online January 2027. The delay pushed it to what
Speaker 3
time? That is our current activation. Yes. Okay. Yes.
We were assuming that it was going to to really be, coming online much sooner than that. Okay. So our current activation timeline is January 27.
Speaker 1
And because the savings came from that, is there any need for any outside additional funding to get that online in Giant 2027, or is that funding already ready to go for that activation? That funding is ready to go. Okay. Great. Thank you.
Okay. No further questions on the overview. We're gonna move on to issue number two. Gonna hold that item open.
Speaker 5
My microphone on? Okay, there we go. Mark Beckley, Chief Deputy Director for Operations for the Department of State Hospitals. I'll be talking about the patent in NAPA electrical infrastructure projects. For NAPA, we proposed 7,270,000 in general fund for the working drawings phase of the electrical infrastructure project.
This project will upgrade the electrical distribution infrastructure from 2.4 kilovolts to 12 kilovolts distribution system and includes the replacement of existing PG and E transformers, substation, utility feeder lines, facility transformers, switch gears, and installation of new generators. For the patent project, we proposed $1,760,000 in general fund for the preliminary phase four plans to provide upgrades to DSH patents electrical infrastructure. This project has two phases. The first phase is to upgrade the medium and high voltage elements within the electrical distribution system. And the second phase is to upgrade low voltage electrical distribution at each of the buildings, replacing old panels and wiring.
The electrical infrastructure for both of these hospitals were installed in the 1970s, and these systems are reaching the end of their useful life. These projects are necessary to ensure resilient and reliable primary and backup electrical flow to our facilities to support critical HVAC, lighting, alarm systems, medical equipment that protect the health and safety of our hospital team members as well as our patients. In the agenda, there's a question about why fund the project now. These projects really are critical to ensuring that these hospitals can continue to operate and to protect the health and safety of our team members and our patients. It takes approximately seven years to complete projects of this magnitude.
And what we really want to avoid is any sort of like downtimes in electrical distribution, any resulting adverse impacts to our team members and or patients. The second question in the agenda asks about DSH's long term infrastructure plan for its facilities. And I'd like to start by describing the process about how we determine our infrastructure priorities. So the DSH Sacramento facility team and their architectural engineering consultants regularly meet with hospital team members, including executive management, plant operations, hospital administrators, clinical and safety team members to identify the infrastructure needs that pose significant threat to the operations of the health and safety of hospital team members and patients. From this information, the DSH Sacramento facility staff and their consultants then use a risk based, data driven methodology to prioritize projects that have the greatest potential impact to the severity to staff and patient health and safety.
Some of the criteria that we usually look at and make these determinations, and these are in rank order, are the life safety and security risk for patients and staff, frequency and severity of system failures, age and functionality of our buildings and infrastructure, impact on patient care and hospital operations, regulatory or compliance deadlines, and opportunity to bundle different projects for efficiency. After we create this prioritized list, the DSH Sacramento facility team members then meet with DSH Sacramento executive and hospital executive team members to prioritize the list of projects. So I will describe what the core category of projects and examples of some of the projects in these categories are. The first category, I'd say, is to extend the useful life of our facilities. So I had mentioned the electrical systems upgrade projects.
In addition, we also have roof replacement projects for 12 patient buildings across all of our hospitals. Two of those roof replacement projects have been completed and 10 are currently underway. Associated with the roof replacement projects, we also have the upgrade and replacement of our existing HVAC systems. The second category is our safety projects. So currently, we have fire safety and anti elicature projects underway at our hospitals.
We have fire alarm upgrades underway at our DSH Metro and Patton facilities and fire sprinkler and water line improvements at Metro and Kolinga, with future fire safety projects planned for Napa and Itascadero. We also have anti ligature projects underway at four of our older hospitals, NAPA, Atascadero, Metro and Patent. And then finally, I'll mention our DGS sponsored sustainability and energy efficiency projects. We have solar projects, LED lighting, EV charging station projects across all of our hospitals. And I'll also note that the HVAC units that we're installing as part of our roof replacement projects are also replaced with highly energy efficient systems.
And I am ready to take any questions that you have.
Speaker 1
Department of Finance, anything to add? Well, anything to add? Oh, yeah. No. Okay.
Great. Thank you. So these are being proposed as one time funding, but they're part of an ongoing funding proposal. So Department of Finance, are the ongoing charges or ongoing costs being calculated in the structural deficit?
Speaker 6
Good morning. Matt Schuler, Department of Finance. Do you mean, like, the operation and maintenance, or are you talking about, like, ongoing costs for
Speaker 1
the next So there's this is like, this is for at least for the NAPA one. This is part two of the request. Last year was a onetime, but then, again, coming back for a request. And it's gonna lead up to, I think, $95,100,000 total. So they're ongoing budget requests.
I'm wondering if the rest of the funding is being calculated under the structural deficit.
Speaker 6
Well, what I would say is I would point you to the five year plan or the co BCP where we would note, for example, each phase is one time. And we typically, depending on schedule, if we're able to schedule it sequentially each year, those funds for that phase is a one time request.
Speaker 1
But the project as a whole is ongoing the request for funding is ongoing. Like, I don't know how long it would the requests are gonna I think until to lead up all the way to $95,100,000 we're going to have to calculate into our structure deficit for at least, what, four, five years. Is that correct?
Speaker 6
Correct. Yeah. We would build it into our multi year. So, for example, 2627 for NAPA, as an example, electrical infrastructure upgrade. We've got 7,200,000 forking drawings.
We've logged 84,900,000 for construction in 'twenty seven, 'twenty eight, and that would essentially end
Speaker 1
the one point Yeah, and then anytime. 8,000,000 So is it being added? Is it included in our structure deficit?
Speaker 6
Well, in our multi year view, correct. Yes, we do calculate. We do calculate as lump sums per department, yes, for these projects that were proposed Okay. To look at as the
Speaker 1
years I'm wondering, though, because once you start a project, I think it would be silly of us to stop the project in the middle of it. You'd have to continue. So I'm wondering why our department of finance proposes these type of PCPs in a different manner, where other PCPs are x amount this year, x amount the next year until the project is complete. And this is being proposed as a one time, which I don't view it as a one time because you have to come back to continue the project.
Speaker 6
I believe I'd characterize this as one time to say in the finance letter's example to let you know that for this particular budget year that it's just the one phase that's being requested. But the methodology actually provides some flexibility. If we come to a more deteriorated state next year fiscally and we have a phase, yeah, would
Speaker 6
it would be unfortunate to halt the project. But for perhaps a 5% cost increase delaying it a year or two, legislature would have the flexibility to do that. Okay.
Speaker 1
Well, I don't I I don't anticipate that administration ever come in and say, let's delay what we've already invested in. So I'm but but okay. So we're already in with the NAPA. With the patent, if we approve this, we would have to be all in to approve the 61.7 estimated cost, and then that would increase to x, y, and z. Mister
Speaker 1
Yes. I'm so sorry. I forgot your title, I apologize. I'm not I'm not using it. Whatever you're allowed to do without sugarcoating, like, is patent going to fall apart if we don't start this now?
Speaker 5
Yeah. I mean, I would say the again, it kind of is that balance of risk. Right? Again, you're looking at an electrical system that was installed in the 1970s. It's been stable up until this point.
You know, I'm not an electrician or an electrical engineer to say, you know, when you'd see outages. But that is a real critical question and issue. Again, given the time frame it takes to implement these projects, which can take as long as seven years, if you do lose a transformer, sure, you could do piecemeal replacements. But again, a transformer is a very large specialized piece of equipment. And so it would take a while to actually install it.
And there may be emergency workarounds that we could do. But, you know, I guess our concern here is it's it's very outdated infrastructure, and we do get concerned about the risk of failure.
Speaker 1
When I got briefed for state hospitals, the first thing I asked, I was like, Nore, tell me how many BCPs we have on sewer, electrical, or what they need to upgrade? Because I knew one was coming. I knew it. I'm surprised it's only one request, but you grouped two into one. So I guess it's two.
On the NAPA one, did we already complete the preliminary plans phase of the project?
Speaker 5
Doctor. I have our Chief Operating Officer, Robert Horsely, can respond to that question.
Speaker 7
Doctor. Hi. Oh, hello. Thank you. We actually are waiting for DGS to hire their architect of record.
And so we are about 10% into the preliminary plan phase right now.
Speaker 1
But the request is already coming for the second part, but that first one hasn't even it's nowhere near even 50%. So there's a potential of this request not even needing to kick in until the next fiscal year?
Speaker 7
Well, no. It's there's each phase, preliminary plan phase, working drawing phase. We have to get approval through the Department of Finance and the State Public Works Board each fiscal year once we finish that phase. For the preliminary plan phase, that takes a while for the DGS sometimes to actually get the contractor on board and hired. The funding was sent to them on September, and the funding came to us in July.
So it's just the time period it takes to go through the contracting process sometimes and we're waiting for that part to start. Don't see us delaying another year for the fiscal year to start working drawings phase. The first phase is usually involving the CEQA and going through a lot of those early on preliminary design. So working drawings is when it gets a little more deeper into the drawings and actual project itself.
Speaker 1
How long does the preliminary plan phase start once you actually get this contract out? How long does it take, sorry, for that part?
Speaker 1
So you're not gonna be able to utilize the what you're requesting, $7,300,000 in this next fiscal year? Yeah. You won't?
Speaker 6
Well, typical twelve months is a good rule of thumb, but we asked EGS about this. At Department of Finance, do question that because we will delay phases and not appropriate if the schedule shows that it's not ready. And this particular one was showing that it should be ready by April 27. Correct.
Speaker 7
DGS has A and E retainer contracts. And so they have AORs on contract. It it's a work order process that they go through. It's not a typical solicitation award bid and award that you would see on a normal contract.
Speaker 1
Okay. But the $7,300,000 would kick in in potentially April, three months before the fiscal year is over. Would have to do a contract. You wouldn't even kick it because it doesn't sound like you would use the $7,300,000 in the next fiscal year. That's what it sounds like.
Speaker 6
Well, according to DGS, they're basically estimating that it would take less than twelve months. Twelve months, again, is just a rule of thumb for preliminary plans. But even if we ate into the next fiscal year a few months, you'd still be saving that seven, eight, nine months on the back end of having to wait an entire another year with nothing to do at DGS as far as doing the actual construction documents.
Speaker 1
Okay. Val, did I turn to you? Can't remember. Anything to add here? You're good?
Okay. All right. Thank you. We're going to hold that item open. Thank you.
Move on to issue number three.
Speaker 3
Hi. Chief Deputy Director, Program Services, Chris Edens, and I'm joined by Stacy Camacho, Deputy Director of our Community Forensic Partnerships Division, which oversees our conditional release program. This is a, budget change proposal about, Senate Bill three eighty. The department is proposing $469,000 one time in the budget year to support two one year limited term positions to implement, Senate Bill three eighty. This bill 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 its findings of the analysis by 01/01/2027.
The resources requested are needed to complete extensive research and analysis of transitional housing models and laws that are in other states, as well as, extensive research on the current law here in California. Resources also include operating expenditure funding to support travel to visit a few of these programs out of state and to consult with subject matter experts. The analysis will look at potential program designs, estimated costs, and identify statutory barriers to establishing this type of facility in California. That concludes my presentation. Open to any questions.
Speaker 1
Yeah. A couple of questions under this program. Where are we currently housing people? And how many people do we have on the ConRAP SVP programs?
Speaker 3
Sure. Yeah. Currently, I think we're at a census of about 17 to 18. We fluctuate anywhere from 17 to about 22, 23 individuals out in the community. As you imagine, it's very difficult to find placement.
Placement is, by statute, required for individuals to be placed in their county of domicile, which is determined by the courts. Usually, placement looks like an individual residence within the county of domicile, so a single family home.
Speaker 3
Until the court deems that they are no longer either no longer meet the criteria for SVP and may be unconditionally discharged, or they may be rehospitalized during their time in ConREP if there is a violation of their terms and conditions of participation in the program. Off the top of my head, I don't know the length of stay, so I'll look to to deputy director, but it usually is a few years in the program. It's not it's not indefinitely? No. It's not indefinitely.
Speaker 3
No. No individuals have to continue to meet the legal criteria for continued commitment as a sexually violent predator.
Speaker 1
Okay. And then how much does it cost us? If it's, like, 17 to 18 people, single family homes, they're all living separate. Right? Single family homes across California?
What's the annual cost? Department of Finance, do have those numbers, or does someone have those numbers?
Speaker 3
We can follow-up with that. Last time we had taken a look at our, annual cost per patient, it was running around $350,000 to $400,000 per year.
Speaker 3
No, that is for all inclusive services, housing, supervision. So annual cost per person,
Speaker 1
Do you anticipate the report coming out of SB380, are there other avenues that are more cost efficient to providing housing?
Speaker 3
That's what the analysis will touch on. We did do an initial sort of internal consideration of this. This issue was initially flagged in October 2024 by the California state auditor. There was an audit report that was released on the current rep SVP program, and it did recommend at that point that the department explore the feasibility of establishing state owned transitional housing. We actually formally disagreed with that recommendation.
And the biggest for a number of different reasons, but really the the biggest issue is that we did not see that transitional housing would ultimately solve the problem of placing individuals in their county of domicile. Because ultimately, even if we do have a transitional facility, at some point, the court is going to then require and the individual is then ready to step down back into their community. And so we will still be faced with We're in a task of having to place individuals in in their county of domicile. Oh, interesting. So is it gonna cost us more then?
Essentially, yes.
Speaker 1
Oh. Oh, okay. Interesting. Okay. Anything to add?
Director Sicel Javier, I wanted to ask you another question on the IAC that we were talking about before. Yeah. Sorry. I know I think either one of you mentioned that, you know, the goal is to go back into the communities, and that's the ultimate goal. But does that mean, like, will counties have the support, the funding available to house these individuals if the whole goal is to divert away from IST into the community?
Speaker 2
So on SB thirteen twenty three, when they are diverted through SB 23 in the interest of justice, and they are ultimately diverted, the bill also included a change to 4,361, which is our statute for DSH diversion, and allows the DSH diversion program to continue to pay for that. So, whether they get diverted in the interest of justice or they get diverted after the finding of IST and referral to pathways, they will receive funding under the DSH Discussion Program for that.
Speaker 1
So the IST solutions, it sounds like they can be used in other areas to support that same kind of population.
Speaker 2
It would be just for individuals found incompetent to stand trial and felony charges.
Speaker 1
As we divert more people away from IST, I guess maybe go back to the same question. Because you said, yes, it allows for that ability to fund and pay for
Speaker 2
that covered with the same funding. But then you said it's only used for IST, the funding. Right. So an individual under SB thirteen twenty three is first found incompetent to And stand then the court makes the decision whether it is in the interest of justice or not. They're actually going to, yeah.
So, if it's not in the interest of justice, they're still incompetent to stand trial. That finding hasn't been removed. So, they're incompetent to stand trial, but the court is looking has options for community based treatment. If they land in a diversion program, that diversion program will be funded by the DSH diversion program.
Speaker 1
Okay. So funding can be diverted there. So the IC Solutions of how much we're saving in the past three years, that is not being taken away from that kind of okay. No. Okay.
Alright. Thank you. No. We're gonna hold item three open. Move on to issue number four.
Speaker 2
For this item, I'm joined by Brandon Price, who is our Chief of Hospital Services. And the department requests $3,900,000 and four permanent positions in fiscal year 'twenty six-'twenty seven and $1,100,000 in fiscal year 'twenty seven-'twenty eight and ongoing to support dental services provided to patients at DSH Metropolitan and Patton. This proposal includes 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 include three dental hygienists and one dentist to provide adequate staffing levels to meet patient dental care needs and align resources at DSH Metropolitan and DSH Patton with that of other state hospitals. Patients residing in the state hospitals often exhibit complex medical, psychiatric, and cognitive conditions that place them at elevated risk for poor oral health outcomes.
The increased hygienists will focus on preventative care, allow dentists to prioritize urgent restorative care and exams. Happy to take any questions.
Speaker 1
Okay. No questions here. I'll hold the item open. And thank you for joining us today. Thank you.
Moving on to our next, commission for behavioral health.
Speaker 4
Good morning. Brenda Grailisch, Executive Officer for the Commission for Behavioral Health. Thank you so much for the opportunity, Chairman Gjavar, to provide a brief overview of the Behavioral Health Services Oversight and Accountability Commission, also referred to as the Commission for Behavioral Health, and our focus during the transition to the Behavioral Health Services Act from the Mental Health Services Act. So, we are an independent agency led by 27 commissioners, and by statute, our membership reflects the breadth of the public behavioral health system, including consumers, providers, family members, community members, and state partners. That structure isn't intentional, as we're designed to surface challenges from multiple angles and develop solutions with a consistent focus on accountability and outcomes for Californians most affected by the public system.
Our primary tools are data and policy research, program evaluation, grant making and technical assistance, and public transparency. We publish policy reports that combine data analysis with stakeholder input to identify what's working, what's not working, and what practices can improve statewide outcomes. We also evaluate programs so that Californians can learn from implementation, improve performance over time, and clearly understand the results from public investments. A key part of our transparency work are public facing data tools, including our Commission on Transparency Suite, which makes behavioral health data accessible to the public and decision makers. On the grant making side, we fund and support local programs and partnerships across the age and care continuum, often pairing grants with technical assistance and expectations for collaboration, helping to reduce silos between counties, providers, and community partners.
We also maintain a consistent emphasis on historically underserved communities through our community empowerment and advocacy contracts, which are designed to strengthen participation and ensure local planning reflects community needs. Under the Behavioral Health Services Act, the Commission's role is evolving in several important ways. First, we continue responsibilities that remain active during transition. So County Innovation Funds can still be encumbered through June 2026, and so we're actively working with our counties to encourage timely, strategic use of those funds and to approve plans. Second, the Commission's pivoting to implementing innovation on the state level through our new Innovation Partnership Fund grant program, which provides up to 20,000,000 annually for five years to support innovative efforts that advance statewide transformation, which I'll talk about in our next agenda item.
The third, we continue major initiatives such as the Mental Health Wellness Act, Behavioral Health Student Services Act, our full service partners' evaluation and advocacy contracts focused on nine specific underserved populations. The BHSA also expanded the commission from 14 to 27 members last January, adding seats that have strengthened lived experience and system expertise across multiple sectors, which focus on mental health and substance use disorders. And right now, we're currently undergoing a look into our strategic plan to do an update to our strategic plan to focus on the BHSA transition. And through that update we're still in the process of it right now, but we're looking to focus on four priority areas: one, including strengthening accountability and results for people with the highest behavioral health needs second is ensuring substance use disorder integration across the Commission's work third is expanding peer services and peer led models and the fourth is building the evidence base for innovations that can be scaled statewide. And I just want to make sure I underscore what a significant moment this is.
The behavioral health transition is an extremely large and impactful system shift that California has undertaken in behavioral health in decades. Implementation at this scale is complex, and it creates new expectations, new planning requirements, new accountability structures, and real operational impacts at the county and provider levels. So, the commission's role at this moment is to really help California make this transition real and workable, to gather what is happening on the ground across our counties and our communities, to bring transparency to how funds, programs, and outcomes are aligning with the intent of the law, to surface what's working and where barriers are emerging, and to translate those lessons into practical improvements through data evaluation, technical assistance, innovation, and recommending strategies to improve implementation of the Behavioral Health Services Act over time. Any questions on our overview, or No.
Speaker 4
jump on into the next one. So, with our Innovation Partnership Fund, I think Issue six, everyone. Oh, okay, sorry. Thank you. So, was a great background on the agenda on our Innovation Partnership Fund work.
Under the Behavioral Health Services Act, innovation moves from the county level to a statewide strategy. It's this change is allowing California to identify what works, to build a stronger evidence base, and move effective models beyond single county pilots so that promising practices can be tested with rigor, can be evaluated consistently and scaled across regions, and it also creates a vehicle to advance statewide priorities while leveraging local expertise and community defined solutions. So throughout 2025, the commission held extensive listening sessions with the community, which included providers, counties, state partners, a variety of stakeholders, to inform the development of a framework an innovation partnership framework that morphed into a request for application for the first $20,000,000 allocation of the Innovation Partnership Fund. That RFA was released on March 20. The fund offers two distinct grant categories: one for small grants, exclusively for community based organizations, nonprofit entities, and tribal organizations.
So, we're looking to have at least eight grants under 500,000. And then one for large grants that's open to all, including public, private, and nonprofit entities, and we're looking for at least three in that category for between 500,000 and 5,000,000. The interest has been substantial. So, since we released the RFA in March, we've received over 400 questions and have held two bidders conferences with over 1,000 participants. So given that level of engagement, we are anticipating a quite robust pool of applications, which are going be due on May 8.
So the timeline to announce the awards we're anticipating would be in mid June, and we would be looking to start those contracts in alignment with the BHSA local BHSA implementation on July 1. And then right on the heels of that, we will begin planning the next round of Innovation Partnership Fund work. Did you want me to stop there or continue to the next question? Okay, Okay, go to the next so another one. In terms of the types of awards the Commission's considering as innovative, those include innovation solutions that could be pertaining to services, technology, training, tools, or any other modality or format that improves Behavioral Health Services Act programs and practices, with a focus on the BHSA priority populations.
And so, just as a reminder for those that might not be tracking those BHSA party populations that are defined in statute, which are those who are at risk of homelessness, institutionalization, conservatorship, involvement with the justice system, and or involvement in the child welfare system. And so, to be eligible for this grant program, proposed solutions must be innovative. We have a definition of innovation. It needs to address the needs of these BHSA priority populations, and then needs to apply to or support county implementation of programs or practices to best serve the BHSA priority populations. And so, for the purposes of this first round RFA, the Commission, we're defining innovation as a new or adapted or expanded approach to solving persistent problems in California's public behavioral health system, especially those that relate to equity, access, workforce expansions, any service fragmentation, and anything that can enhance the quality of services.
And so, to be considered innovation, a project has to advance to newer culturally competent models, tools, partnerships, or technology that's not widely implemented in California. It needs to introduce or scale practical community centered solutions that increase access to behavioral health services. It needs to be or demonstrate a clear break from the status quo. It needs to be actionable and ready for real world implementation, and it may include ideas from other sectors or geographies adapting adaptation to promising practices in new areas, or bold new models co created with people with lived experience. So, at its core, innovation is about transforming how care is delivered with impact, with equity, and with dignity.
Finding the time and capacity to design, test, and evaluate new approaches is genuinely difficult. By moving innovation to the state level under the BHSA, the Commission has an opportunity to take on more of that forward thinking function, creating the space needed to do the piloting, measuring, and scaling of solutions that counties can adopt without having to build everything from scratch. So thus far, the response that we've received on the RFAs is encouraging, since given the high level of interest. So we're hopeful, and we intend to translate that interest into some actionable projects with measurable outcomes to support counties and improve results statewide. And moving to the last question on the Innovation Partnership Fund and how we'll ensure that these resources are able to have the same level of impact as they had at the county innovation level effort, I guess just to make sure that everybody is aware, the counties can still fund innovative pilots under the Behavioral Health Services Act through the Behavioral Health Services and Supports component, and that makes up about 35% of county funds.
But unlike under MHSA innovation, the BHSA no longer requires the commission to approve those projects. And so innovation is now one new option within that bucket alongside other allowable uses for counties that also includes things like early intervention, So that counties can retain their flexibility to innovate locally, while the Innovation Partnership Fund at the state level creates that dedicated statewide pipeline to test, evaluate, and scale approaches that counties can later adopt. At the same time, the Innovation Partnership Fund is smaller than the private prior MHSA innovation structure, so our approach is to maximize impact through our projects by and really looking to impact how changing how innovation happens. So really, by taking the burden off a county, since under the old model or the previous model, each county had to design and administer innovation while also running its core system, the commission has the opportunity to do that in a dedicated space. Secondly, it creates a statewide pipeline for innovation, so not just for counties or from counties.
So, we're seeing inquiries from a variety of organizations, including community based organizations, tribal partners, universities, the private sector. And that matters because some of the most scalable ideas are happening outside of government or are being researched at our universities. At the same time, we're being clear that their proposals must benefit county behavioral health programs and again support their implementation, their ability to best support and serve the BHSA priority populations. Third, we're designing for scale and adoption, so really looking to have that system wide impact and improvement impact, so not just doing one off pilots. And the goal is to generate innovations that can go beyond a single project, produce measurable outcomes, and reduce fragmentation so counties can adopt what works without having to start from scratch.
So even without the dedicated dollars, the IPF has the potential to derive these really big statewide impacts and really build capacity in our state.
Speaker 1
So I'll stop there. Anything to add, other of you? Okay. Quiet over there today. Thank you so much for a really robust in-depth background on that.
Painted a really a good picture that I could understand. On the small and large grants that are available, and I'm excited to see what comes out of the announcements on June 15, how long do we anticipate this funding to last? Or do we give them a timeline, or do they give
Speaker 4
It would probably be three year contracts that we would be doing with them. So it wouldn't be just one year of funding to hurry up and do a project. They've had time. So we would take the funding allocated to them, enter into the contracts, and then monitor those over time to make sure we're progressing on the projects.
Speaker 1
After that three year, are they allowed to apply again for extended funding? Doctor. You know,
Speaker 4
we haven't operationalized all that yet, so I think this is all in development. And so, is our first time working on this. I think there's nothing that precludes us. At first blush, I'm not aware of anything that precludes that. It's an interesting question.
And so as soon as we're done with this round of grants, we're gonna start our next planning for our next round
Speaker 1
as well. Because this is $20,000,000 forever, however long this continues, right?
Speaker 4
Well, it's for it's $20,000,000 per year, and we get that allocation every for the next five years. And then post, what, 2031, I think, is that what that takes us out to? Then we'll have to start asking for more through budget requests.
Speaker 1
Got it. Yep. Okay. And can can they apply for both the small and large or one or the other?
Speaker 4
That's actually a great question. I think I can remember seeing it in the RFA. There are some limitations, but I think if they do apply for more than one grant, they have to go for separate they have to separately apply for them. Don't know. They can?
Okay, Sorry. Was just looking at my team. Yep. They said that.
Speaker 1
Can I? Thank you. And then so you mentioned you gave a descriptor of what is being considered innovative. It's not like something they've been doing, and they just want to expand that. Right?
It's all brand new.
Speaker 4
Could be expanding to a new population. So say you tried something in one county, and now you want to try it in another county, that could be considered innovative.
Speaker 1
I don't know if you have the answer to this right now. But later on in this year, we're going to be hearing about mobile unit Prices. Mobile prices units. Yes. It was a pilot program investment.
I don't think it's a pilot program. It was investment. The funding expires. Even though we've done that for a couple years for expanding it, would this qualify as an eligible innovative to expand into other areas? Or is that to
Speaker 4
Well, if it's something that's going to be new, it'd have to meet that definition of So whatever would be done would have to meet this within these parameters of that definition of innovation.
Speaker 1
You gave an example of training. So, if they just want to train their employees, that covers it?
Speaker 4
Like, if there's a new training that they're and so somebody's looking to train a workforce on some sort of new something or new program or practice, then if it was an existing one, it wouldn't meet the definition of innovation. But if there was something new that was a new way of doing things, then that could potentially be. Okay.
Speaker 1
That that's a little worried because I'm like, don't wanna see campaigns. I don't want to see public campaign or, you know, awareness being funded through this. I don't want to see train like, I want to I hope, as the commission approves this, they're, like, actual service deliveries kind of innovative investments.
Speaker 4
I will say, too, part of the statute signified that the commission would work in collaboration with CDPH, HCAI, and DHCS. So, that has been part of our work through all of this. And so, we would definitely want to stay very coordinated with that. And CDPH now has that population based prevention. And
Speaker 1
just to clarify, post the five years, there's a potential for the commission to say, hey, we've been funding this for the past five years. We no longer have bond money. We would like the general fund to keep funding them. Or not for funding the grants for Yeah.
Speaker 11
Oh, Will Owens with the legislative analyst Office. I'd like to so the commission would probably have the opportunity the state has up to 3% funding from the BHSA of total revenues to use for behavioral health initiatives. So that's an area of money if that wouldn't be general fund that the commission could
Speaker 1
the legislature. Okay. Thank you for that. It's my understanding. Okay.
Thank you. We're gonna hold the item open. Okay. Great. We'll have to issue number seven.
Speaker 4
Okay. So issue number seven, the All Youth Drop In Centers extension. So this is a proposal to extend the liquidation deadline for our All Cove Youth Drop In Centers grant program. And this model was adapted from a successful international youth one stop shop model that was initially developed in Australia, and then moved to Canada and Ireland. And it is they basically are standalone, youth friendly centers where youth ages 12 to 25 can access support for mental health needs, physical health, substance use, peer support, supported education and employment, and family support.
Al Cove in California initially began as a Santa Clara County Innovation Plan project in partnership with Stanford, which helped create and refine the model. Subsequently, the Budget Act of 2019 included $14,600,000 in one time grants over a four year period of time to support the establishment and expansion of All Cove models statewide under the commission. So in January 2020, the commission allocated $10,000,000 for site grants and $4,600,000 for Stanford to provide technical assistance and conduct an external evaluation. So that investment has resulted in five alcove sites, which are in Palo Alto, Beach Cities, and San Mateo all three of those are open as well as San Juan Capistrano and Sacramento, which are both open for some services but are working on their fidelity to be able to have grand openings in the near future. So just for clarification, this proposed extension that we're asking for, this reallocation, is separate from what's been done with the Children and Youth Behavioral Health Initiative Rounds four and five grants, which went to some all co centers.
So while the Commission helped had conducted the CYBHI round four and five grant procurements, all those grants are administered by the Department of Health Care Services. All those grants all that funding has been allocated and disseminated to their sites. The Commission, however, holds the still holds the technical assistance and evaluation contract with Stanford for all of the alcoves. And really, that work is to support the implementation of all of the alcoves and the evaluation efforts. So for this particular reappropriation for our commission funded alcove sites, we're requesting an extension of the liquidation deadline for up to $4,062,000 of the remaining one time behavioral health services funds to support the finalizing of these All Cove projects, the Commission's All Cove projects.
There were some delays in site development and staffing and shifting in funding structures. And while all of our CBH funded centers are operating, like I mentioned, not all have met the full fidelity. There's a couple that are still working on that. So, we're looking to have that extension so that we can continue the funds, so that they can just finish spending down the remaining funds. Otherwise, they revert on 06/30/2026 so just in a couple months before they would be able to finish their implementation, stabilize operations.
And I really wanted them to finish collecting that data so that we can have the data for all of the sites for the final evaluation. So basically, able to get this reappropriation will help protect our state investment, allow these programs to finish implementing as designed, and making sure that Stanford can get all is the independent TA entity and their evaluator to get enough data to evaluate and produce the final report for us next year, next spring.
Speaker 1
Great. Okay. I have no questions for you, either. Thank We're you so going to hold the item open. Okay.
Thank you for being us with us today. We're gonna move on to our fire department, DHCS. We'll start with issue eight on an overview on the behavior programs overview.
Speaker 12
All right. Ready for me to Yes. Jump Thank you. Paula Wilhelm. I'm the Deputy Director for Behavioral Health at DHCS.
And my colleagues with me today are Marlies Perez, who is our Project Executive for Behavioral Health Transformation and also our division chief for community services. And then I also have Ivan Bardwaj, who is our division chief for Medi Cal behavioral health policy. So I will jump in first. The committee requested a brief overview of significant program changes related to our Medi Cal specialty mental health or Drug Medi Cal, Drug Medi Cal organized delivery system services for the 'twenty five, 'twenty six, and 'twenty six, 'twenty seven state fiscal years. So during this time period, the department has continued to focus on implementing the behavioral health components of California Advancing and Innovating in Medi Cal, or Cal AIM, while also launching new benefits and activities under the Behavioral Health Community Based Organized Networks of Equitable Care and Treatment Initiative, which I will now refer to as BH Connect.
As you may know, CalAIM benefits and policies for behavioral health included the launch of Medi Cal Peer Support Specialist Services, mobile crisis services, contingency management services, also known as recovery incentives, and more recently, traditional health care practices. Caliim was also focused on updating our administrative policies in order to reduce complexity for our plans, our providers, and our Medi Cal members, and improve behavioral health access and quality. So some of the policy updates we've made include updated criteria for access to specialty mental health services, our no wrong door policy for mental health, standardizing screening and transition tools to help people access mental health services, updates to our clinical documentation requirements, and behavioral health payment reform. So we continue to update those policies in response to feedback. And early this year, we finalized and published refinements to guidance on the specialty mental health access criteria.
So we now have a list of DH approved youth trauma screening tools that can help practitioners determine when youth meet the criteria to access specialty mental health. We also made updates to our standardized screening and transition of care tools for mental health services, and those were to allow practitioners to intervene or override the screening tool direction based on their clinical judgment. And
Speaker 12
that in response to, you know, watching implementation play out and getting feedback about areas where different or further guidance was needed. So a new CALIM priority that we'll be focused on in fiscal year 'twenty six-'twenty seven will be the implementation of updated standards for substance use treatment, or SUD, provided through our Drug Medi Cal and Drug Medi Cal Organized Delivery Systems. You'll hear me say DMZ ODS for Drug Medi Cal Organized Delivery System repeatedly here. Under existing law, Drug Medi Cal and the DMCODS providers must use American Society of Addiction Medicine, or ASAM, criteria to determine the appropriate level of care and treatment services for Medi Cal members. So, ASAM has now released new clinical standards, referred to as their fourth edition standards, that must be adopted both in Medi Cal as well as by DHCS licensed SUD treatment facilities, which we'll touch on in a later issue.
So, throughout the remainder of this year, DHCS will be engaging stakeholders to develop guidance to adopt these new standards throughout our SUD treatment systems to support continued use of evidence based high quality care. And we anticipate publishing final guidance on this in early twenty twenty seven so that our systems can implement by July 1. I also I want to take a minute to highlight really promising data also in the SUD space regarding our DMCODS contingency management benefit. So this was, of course, started as a pilot program, which has now served more than 13,000 Medi Cal members, And we have more than 119 active sites in 21 DMC ODS counties. So, we have seen real growth in this.
And we're also excited about the data that shows the efficacy of this evidence based intervention for stimulant use disorders. So we have seen that ninety five percent of our Medi Cal members who receive contingency management test negative for stimulant use over the course of their treatment, and that ninety five percent exceeds the average of eighty five percent that we generally see in the literature on this service. We'll also mention that those 21 counties that are providing contingency management cover approximately eighty percent of our Medi Cal members right now, so we're really looking forward to continuing to build this capacity for this important service. Over the course of 2025, we also worked closely with tribes and tribal partners to implement Medi Cal coverage of traditional health care practices. So this was an exciting first in the nation approval that we received alongside three other states in 2024.
So 2025 was our initial year of implementation. Traditional health care practices are intended to improve access to culturally responsive care for our American Indian and Alaska Native Medi Cal members who are seeking care for substance use. Traditional health care practices are exclusively offered through our Indian health care providers, or IHCPs, for Medi Cal members in all of our DMC ODS counties. So this is a requirement for DMC ODS counties if they have an IHCP that chooses to participate to cover those services. We released our initial implementation guidance on this benefit in March 2025, And at this point, we've approved 21 IHCP's Indian health care providers around the state to serve Medi Cal members with traditional health care practices.
We'll also mention that we were initially authorized to cover traditional health care practices for two years and change, so just through the December 2026. But we do plan to seek renewal of this opportunity for up to five years in our forthcoming CalAIM Section eleven fifteen waiver renewal application. So really hoping we'll get the opportunity to continue building and expanding on this. Shifting to talk about BH Connect, which continues to be another area of focus for us. You may know and remember that BH Connect is a group of policies designed to strengthen and increase access to a continuum of community based behavioral health services for our Medi Cal members who have the most significant behavioral health needs.
So, to date, we've implemented multiple components of the BH Connect initiative. In 2025, we were able to launch our $1,900,000,000 Access Reform and Outcomes Incentive Program. So this program creates an opportunity to reward our county behavioral health plans for improved performance on quality measures. And we did make initial payments totaling $48,600,000 to 42 counties based on their progress on these measures, and that's consistent with our planned schedule. So by the end of this year, they'll have an opportunity to earn quite a bit more for their performance during calendar year 2025.
DHCS is also working really closely with the Department of Healthcare Access and Information, or HCAI, to launch the Behavioral Health Workforce Initiative. So, this is a $1,900,000,000 program to expand our behavioral health workforce in Medi Cal. In 2026, will DHCS and HCAI will offer rounds of loan repayment and behavioral health fellowships, as well as scholarships, training for our community based providers, and also grants to behavioral health services providers at the organization level so that they can provide recruitment and retention incentives to their workforce. Notably, all award recipients, since these are Medi Cal dollars, must commit to providing services in a Medi Cal behavioral health setting for a period of two to four years. Also, under BH Connect, we have been able to expand Medi Cal coverage for key evidence based practices.
We have a total of nine counties that have already taken up the opportunity to cover some of these evidence based practices at County Option. These include highly effective models like Assertive Community Treatment, or ACT, coordinated specialty care for first episode psychosis, and supported employment services. Many of these services are also required for counties to provide as part of their Behavioral Health Services Act implementation, effective July 1. And so BH Connect offers counties the opportunity to draw down federal funding for these interventions and use Medicaid dollars to help build out those BHSA required programs. Counties that commit to implementing a full suite of new evidence based practices also have an opportunity to receive federal financial participation for short term stays in inpatient or residential facilities that qualify as institutions for mental disease, or IMDs.
As of April 2026, we have four counties that have been approved to participate in this mental health IMD program and will be focused on building out those evidence based services and reinvesting the additional federal financial participation that they will receive. And those counties are Riverside, Santa Clara, Sacramento, and San Diego. So looking forward to supporting their efforts. Finally, as of 01/01/2026, our transitional rent services, which are offered through our Medi Cal managed care plans, were implemented and became available specifically for the behavioral health population of Focus. So individuals with significant behavioral health needs may qualify for transitional rent.
Looking into this year, between January and July, still sort of the final push on getting our BH Connect implementation guidance out. Specifically, we're looking forward to finalizing guidance to support implementation of several key initiatives focused on children and youth. Notably, we will issue updated standards for coverage of high fidelity wraparound for children and youth, and that will take effect July 1. Alongside these updates to Medi Cal coverage, again, fidelity wraparound will be part of the BHSA implementation. So this is an evidence based intervention to support youth with complex and significant behavioral health needs, and it will be used for youth who are accessing care through Behavioral Health Services Act or BHSA full service partnerships.
Finally, we anticipate launching our Activity Funds initiative by July as well. Activity Funds is a really innovative opportunity to support strengths building and wellness activities for child welfare involved youth, specifically, again, through the Medi Cal program. So the next couple of questions in the agenda were focused on Behavioral Health Services Act, or BHSA, implementation. Before I move to those, were there any? Okay.
We'll keep going. So the committee had asked if the administration tracked or analyzed local county behavioral health programs that may be defunded due to the reallocation of funding included in the BHSA, and also asked about how the department plans to address any loss of reach or capacity represented by the closure of local programs. So, first, I think DHCS really wants to acknowledge the incredible engagement and thoughtful feedback, recommendations, and concerns we've received from our counties, our providers, a whole array of behavioral health stakeholders, community members, and from the legislature as we are working to faithfully implement the Behavioral Health Services Act statute. This was a vision for transformational change that requires fundamental updates to the way counties organize and finance public behavioral health services and the way they prioritize populations, which Brenda alluded to earlier. So as we all manage that change, we recognize there will be difficult local decisions about how to prioritize spending and many implementation challenges to navigate and respond to.
The BHSA did reimagine the required program components that were formerly under the Mental Health Services Act to ensure the BHSA priority populations receive evidence and community based services. So you're familiar with the three BHSA categories of housing interventions, full service partnership, and behavioral health services and supports. Counties are required to develop three year plans that address these identified priorities. DHCS is committed to then monitoring county performance and progress toward our statewide behavioral health goals as implementation proceeds after July. We have primarily heard from stakeholders about reductions in local prevention oriented contracts in response to the shift in responsibility for BHSA prevention activities to a statewide strategy that is managed through the Department of Public Health.
We do not track or analyze specific contract changes or cuts that might be made at the local level. Our focus is on ensuring that counties submit complete and compliant three year implementation plans, which they just completed their draft plan submissions and are moving to final, and that they spend their behavioral health funds according to those plans. Then, again, we will look to see them demonstrate improved outcomes consistent with the intent of the act. So we also want to note that as we are doing change management in partnership with counties, providers, and the community, the BHSA is really intended to work in concert with a host of other behavioral health initiatives that have launched in recent years. So, we have opportunities to bolster existing projects, add new benefits, and provide counties with additional funding, as well as support from other payers.
So, some of these complementary initiatives you're familiar with include CalAIM, BH Connect, and our Children and Youth Behavioral Health Initiative. I think sort of our final note on this point is to emphasize that Medi Cal members remain entitled to receive all of our covered specialty mental health and DMC ODS services from our county delivery systems. So these Medi Cal services must be preserved and prioritized by all counties as a federal requirement, even as they are navigating other changes through implementing the BHSA. So the last part of this issue was some questions about HR1 implementation and specifically the impacts of HR1 on Medi Cal members with behavioral health needs, but those with milder or less complex behavioral health needs who are often served not by the county delivery systems but in our non specialty mental health delivery system. So I would like to share that we will use a two part approach to support people with mild to moderate behavioral health needs throughout the HR1 transition.
We will work to keep Medi Cal eligible Californians enrolled in coverage while continuing to drive improvements in access and quality across our behavioral health delivery systems. So, DHCS's HR1 implementation plan is first focused on minimizing coverage loss to the greatest extent possible. While some loss of coverage will undoubtedly occur, we are proposing key strategies to mitigate the impacts on Medi Cal eligible Californians with behavioral health conditions. So some of these strategies include working to inform our members of changes ahead of time and using clear, linguistically accessible informing materials and member focused toolkits. We're also working to simplify the Medi Cal eligibility and renewal experience and really maximize automation of eligibility determination and verification of work requirements.
And then, finally, we are focused on carefully implementing the allowable exemptions to the HR1 work requirements in compliance with federal guidance. So we'll highlight a couple of specific proposals that the administration has put forward that should support continued Medi Cal coverage, including for folks with the less significant behavioral health or mental health needs. There is a proposed investment of $4,000,000 in total funds for clinic navigators to help guide Medi Cal members through the work requirements process at application and renewal. And there is also funding proposed for an outreach campaign at $17,500,000 total funds, with half of that being general fund that would involve a marketing vendor to develop a tactical outreach strategy to raise awareness. We'd be developing social media tool kits for our providers, our managed care plans, tribal partners, coverage ambassadors to, again, better, more effectively reach and inform our members.
This would also include earned media and paid media in all 19 of our Medi Cal threshold languages. So both of these proposals present opportunities to reach and support individuals with behavioral health conditions, including those who are likely to be served in our nonspecialty system and those who may be less likely to qualify for work requirement exemptions. We are also developing a comprehensive strategy to implement exemptions to the new HR1 work requirements, with a key focus on exempting people with mental health and substance use disorder. So, wanted to take the opportunity to share a few points about this. Wherever possible, DHCS plans to leverage available electronic data sources to automatically identify the individuals who meet work requirement exemption criteria.
So this process is referred to as ex parte and is the most powerful tool we have to maximize retention in Medi Cal and reduce administrative burden on our Medi Cal members so that they don't have to raise their hand, fill out paperwork, say, I qualify for an exemption. We can identify them, and they will have that exemption in the system. We are conducting also extensive research to design one of the exemptions. People who qualify as being medically frail are exempt from the work requirements. So we've been soliciting feedback on the proposed medical frailty criteria from chief medical officers, from our Medi Cal managed care plans, from the American Medical Association, and from external clinicians affiliated with medical societies and disease specific organizations, representing a broad range of clinical specialties to make sure we have a sound definition of who is medically frail and should have these exemptions.
So while that particular exemption will be key to ensure individuals with SUD and significant mental health conditions are exempt from the work requirements, it is accurate that the mental health disorder must be considered disabling to qualify for an exemption under HR1. Thus, the focus of the committee's question on individuals with milder mental health needs makes sense, and we are looking to these other strategies that I mentioned to support them. One last opportunity I'd like to call out that we really hope can help Medi Cal members with a range of needs stay enrolled through HR1 implementation. This is a new proposal that we hope to include in our forthcoming Section eleven fifteen waiver renewal request to our partners at the Centers for Medicare and Medicaid Services. We will seek CMS approval to include employment supports as a county option but to be covered as a Medi Cal benefit to address barriers to employment, support sustained workforce participation consistent with the work requirements, and promote economic stability more broadly among our Medi Cal members who are subject to these requirements.
And so, point of clarification, we have an option right now for county behavioral health plans to cover supported employment services for the population they serve. But if approved, this new proposal that could be administered by any county entity could help make employment supports more widely available to the broader population, not reliant on having significant behavioral health needs. So in addition to these strategies to keep members enrolled in Medi Cal, On the non specialty mental health side, we're also excited to use the new behavioral health performance measures that we've developed as part of BHSA implementation to really monitor the performance of our managed care plans as they cover this population who needs non specialty mental health care. They will provide that coverage while also, of course, partnering with our county behavioral health plans to improve care coordination and outcomes. So some examples of measures that we are looking at under BHSA that will help us monitor progress with this population that uses non specialty services.
We'll be monitoring receipt of core behavioral health services for that nonspecialty population. We'll also be looking broadly at access to medications for addiction treatment, which our managed care plans and our fee for service system can offer. We'll be looking at coordination of follow-up visits after somebody has a behavioral health crisis, and also consistent use of depression screenings to identify people who may immediately benefit from non specialty mental health services. So, we are hoping that all of these interventions can be deployed to help prevent behavioral health conditions from becoming more severe when Medi Cal members access this care. DHCS will certainly continue to communicate closely with the legislature and the broader public as we work through HR1 implementation.
I want to note that we use our quarterly stakeholder advisory committee and our behavioral health stakeholder advisory committee meetings to discuss HR1 implementation updates. These meetings are open to all members of the public. We'll also plan to continue offering HR1 specific webinars and informing materials as well. So, to address the last question on the agenda, DHCS was asked to confirm whether we have generated an HR1 impact estimate specific to individuals likely to be served by county behavioral health delivery systems who may use coverage, we have not generated that specific or focused estimate that you're asking about. So, we very much welcome the legislature's feedback in partnership on these efforts to keep Californians with behavioral health needs enrolled in Medi Cal and the broader efforts that I've spoken about to continually improve access and quality within our behavioral health delivery systems.
Thank you, and happy to hear questions.
Speaker 1
Have some water. There's a lot. Anything to add? Okay. You're Okay.
Good. Can you clarify, when you were talking about the work requirements part, are you saying that the mild to moderate are going to have the work requirements who are under managed care plans?
Speaker 12
Yeah. So the population that is subject to or most impacted by the work requirements are going to be adults ages 19 to 64, who primarily those who are enrolled through the ACA expansion eligibility groups, and then who do not qualify for any of the exemptions. And so there are named exemptions for people who are disabled, people who are actively in substance use treatment, and then people who are medically frail. That's the one I expanded on a little bit. But we do expect that there are a lot of adults in that ACA expansion population who may not meet that exemption criteria.
And so they are the ones who would hopefully benefit from things like additional employment supports, trying to simplify and automate perhaps the redetermination process, etcetera. Okay.
Speaker 1
And then when you were giving examples, when you were talking about the programs that counties are now going to have to reconsider if they're going to be funded since it's not funded from previous MHSA to be an HSA, You gave you gave a couple examples, but two in particular stood out to me, CYBHI and CalHIM. CYBHI, there's not a lot of funding left under CYBHI outside of the just, like, the the hot the hotlines, though? The support platforms, yeah, for youth and maybe fee for service. So, like, how really can CYBHI cover some of the programs that counties are gonna be closing? I didn't see the connection there.
Speaker 12
Yeah. That question makes a lot of sense. I think what we were trying to call out is that these different behavioral health initiatives, including CYBHI, can help broadly support the population with behavioral health needs and also bring in other payers and funding sources. So, under the CYBHI umbrella, for example, we think about school behavioral health and the fee schedule that we've been using and expanding to ensure youth, but also folks in our colleges, can get access to behavioral health services there in schools. So I think we were when when we made that comment, we were meaning to kind of point to there's a lot of different systems and funding sources that we are trying to improve to support people.
Speaker 1
Because when I looked at you know, if if you looked at our the committee's analysis on on this, there's they gave two examples of two different counties. It's a long list of programs that they're gonna be cutting. Are we and I know there hasn't been an analysis, at least on the HR one. But is there an analysis I think you spoke yeah. You did speak a little bit on this.
So just, like, is there gonna be a service gap? Yeah.
Speaker 12
I mean, I think we made the same note that I saw in the agenda, which is that there is now an opportunity for a statewide prevention strategy through Department of Public Health. And so we hope that that will fill potentially part of the gap. And then we will need to, I think, monitor and assess, particularly with this array of different initiatives and funding opportunities that we have in play, to learn what isn't funded or prioritized or where gaps may continue to exist.
Speaker 1
The funding that public health is getting, I don't remember I can't if we spoke about this, but I don't remember any of that covering this direct service delivery. So still a little worried. I'm wondering, you know, how are we gonna continue to get feedback from counties like, hey. These are all done. These are the services we're missing now.
Like, how far in advance are we gonna be able to see that a gap is being created to be able to address and see what we can do in the meantime? Is there opportunity for that?
Speaker 12
Yeah. I think we will need to listen to that feedback carefully and also look at the performance indicators I mentioned. You know, counties do have opportunity and a mandate to fund early intervention. So I think the intent is that there is a prevention strategy. There is some opportunity for early intervention.
There is a requirement that counties maximize their Medi Cal dollars, which should improve their revenue and allow them to reinvest in other types of programs. That's hard when a lot of people are
Speaker 1
going to be falling off of Medi Cal. So it's hard. If we're depending on Medi Cal to cover all of it, but so many are gonna fall off of medical. It's it's it doesn't really you can't turn to that as the saving grace, I I suppose. But you mentioned three examples of what you, at least, or the department's doing to help.
I think you mentioned, like, to inform ahead of time and to try to streamline and so forth, and, hopefully, we can keep people on as much as possible just so the counties can actually turn to those dollars for this. You wanted to add something? Would just oops, sorry.
Speaker 13
It helps to turn it on. I would just add that we are going to be learning a lot through the integrated plan process, because we have all these funding sources that Paula was mentioning that are at the county level. We have seen, you know, and are hearing from our providers, it is a lot in the prevention space, since BHSA funds cannot be used for population based prevention. But as Paula mentioned, we've also heard counties looking some of these providers also provide early intervention services. So, maybe it's helping educate them on what can be provided under early intervention, which is really focused more on the individual, but then perhaps supplementing with opioid settlement funds, which can be used for population based prevention, such as campaigns, stigma reduction, opportunities like that.
So, it is a shifting landscape. As they're working out their plans and their funding sources, I think we are, as Paula said, going to learn a lot, too, as our phase two measures come out this summer. So, there is a lot in flux. But I think there's also, like Paula mentioned, there are different I mean, we're doing so much in California, which I know we all know. But I think with having this integrated plan, we're going to be able to see at a level of transparency that we've never had before as to where our county is putting their funds.
And also rolling out new data systems to be able to see how these individuals are impacted.
Speaker 1
Okay. I'd like to hear a little bit more of that, of what mostly is getting funded. Is it are we actually creating beds? Are are there more expansions, new infrastructure? Can you just dive a little bit more into Sure.
Speaker 13
I'll take that one. I'm happy to take that one. I can say, as of last March, we have granted out $5,800,000,000 of all of the B CHIP funds. So that was the initial investment of $1,700,000,000 and then with the addition of the $4,400,000,000 of the bond. So, in March, we did the bond round two.
But altogether, we have funded four thirty seven infrastructure projects, which is creating an expansion of five forty six either brand new behavioral health facilities or current facilities that are expanding a wing or some type of access. That's creating over 9,553 new residential beds. So that's for mental health and or substance use disorder. And then over 47,000
Speaker 13
Yeah. So those could be so like for mental health facilities, that could be like an MHRC. That could be the new PRTFs. I'm so sorry, these acronyms. Oh, I'm so sorry.
Oh, shoot. I picked ones that
Speaker 12
I don't Mental Health Rehabilitation Center, or Psychiatric Residential Treatment Facility, which is a youth focused setting.
Speaker 13
Yeah. Or like SUD, substance use disorder I know that one, too. Because it's over 20 different facility types, but also like peer respite, so all across the care continuum. But those are the bed types. And then outpatient is more for mental health outpatient type services, like someone coming in for the day, day treatment type services.
Speaker 1
Do you have a breakdown of this is what's available for tribal, counties, NPOs? Who's got sure do. The most
Speaker 13
Oh, boy. I have so much data on this. Let's see here. So I don't know that I have the county tribal. I can tell you about the tribal.
For each of the rounds, we had a tribal set aside, except for the last bond round. But we over exceeded the tribal allotment of the set aside. I think it's over $200,000,000 that we did with our tribes just for the bond alone. And I have to say, with our bond round two, some phenomenal facilities that I know the Yurok tribe, but actual treatment locations. Our first few rounds were more wellness centers.
But with other rounds of B Chip dollars, a lot of mental health and SUD actual treatment services in our tribal partners. I think our counties were around 40% to 50% of the funding. The remaining balance was for our nonprofits, and then a little bit of for profits, but those are for our social rehabilitation facilities, or like a narcotic treatment program that are traditionally more for profit entities.
Speaker 1
And how has the funding distribution gone? Have we been able to smoothly disperse the funds after they're selected?
Speaker 13
Yeah. So, right now, for example, with the bond round two, we're in the conditional award phase. So, we've conditionally awarded 66 projects. But now, they have to we're pulling deed restrictions. We're making sure that they're meeting the match requirements.
So, during this process, sometimes we do have to relinquish an award just because we find out information of maybe they are doing preservation instead of expansion, or their match is not valid and they don't have the funding issues like that. But after that is done, then they enter into contract. I can say, because one of your earlier questions is, what do we have going? What have we actually done? But to date, we have 36 sorry, there's 27 open projects that have 38 behavioral health facilities that are expanded already.
So as of right now, we have four thirty beds in operation and over 4,000 new outpatient treatment slots. And that increases every day. I'm actually going to a grand opening tomorrow in Santa Barbara County for a wellness center. So, are making progress in this space. There have been some issues with cost overruns, just because of inflation and things that we couldn't have predicted when we made these initial awards.
But all the projects are responsible for cost overruns.
Speaker 13
A few things, too, is we did have with the bond a requirement to award counties at least $1,500,000,000 which we exceeded. So that was a statutory requirement. And we also had to do a tribal investment of $30,000,000 So we've met those requirements. And we have a great map on our website that shows the equitable distribution, because we did it geographically, because we understood that some of our more rural partners may not put in you know, have the bandwidth to put in an application as, you know, some for profit organization that might hire a grant writer. But you'll see across, we have a really great distribution.
The only other thing I want to say about that really quick, the LAO did a great report on B CHIP and noticed they wanted to see more in the San Joaquin area and did an evaluation of that and up north. And we have since done a lot of incredible awards. We have, as example, Glen County is going to have their first substance use residential facility in the whole county. And then we have our first tribal peer respite with the Yurok tribe. This is the first anywhere in the state.
I don't even know, maybe the nation. I'm not really so we're super excited about, like, we're hitting these great areas of needs. And then we also have I'm really excited about this in Kern County, our first Fathers with Children SUD residential program as well. So across the state, we've really looked at the geographic need, but also really looked closely at access needs as well.
Speaker 13
So we, with our original B Chip dollars, the $1,700,000,000 we did five rounds. They were smaller. Our first was we had to do $150,000,000 for mobile crisis. All of that funding has been awarded.
Speaker 13
Yeah. We'll talk about that later. Round two was a planning grant. And we really looked through that planning grant process that was for our counties and tribes. And that's actually helped award a lot of funds later.
Rounds three was launch ready, four was children, and then five was crisis. And then the bond, we had just two rounds, the first $3,300,000,000 and the second that we just awarded the $1,100,000,000 So, all those rounds have been completely awarded.
Speaker 1
Okay. Thank you. I have nothing else on this. We're going to move on to Issue nine. And before we get to our mini panel on this, I'll have the department first just do their presentation.
Speaker 12
Thank you. Yes, we appreciate your questions on the $9.88 and community based mobile crisis response trailer bills. I will start by providing an overview of the September TBL and our associated budget change proposal. So the, proposed nine eighty eight TBL authorizes DHCS to establish a new statewide designation process for California nine eighty eight suicide and crisis lifeline centers. So through this or process in the TBL excuse me, we'll talk about the process in a minute we define what will qualify 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 fund will be allocated.
So, really, the nine eighty eight center designation process proposed in the TBL is meant to create a pathway to add new nine eighty eight centers, while also specifying standards for all active centers in order to receive nine eighty eight funding. And we are proposing that this process be implemented no sooner than 10/01/2027 so building in a runway and a planning process. In the TBL, we specify a designation framework, And we refer to sort of basic eligibility criteria, the application and review procedures, and the duration of the approval process. But the intent is to develop process and the corresponding standards for designated nine eighty eight centers through stakeholder consultation, if the TBL is enacted. So to speak to our existing eleven thousand nine eighty eight crisis centers, all of them would need to obtain DHCS designation approval by 12/31/2029.
And we do look forward to supporting and collaborating with existing centers on this effort. We've gotten a lot of questions about our intent with the TBL and the pathway for existing centers. And it really is that we want to create an entryway for new nine eighty eight centers so we can maximize and sustain statewide coverage, and then also implement statewide standards for all centers that are receiving funding. So speaking of those standards, we've specified that we'll address staffing requirements, training, clinical and triage protocols, performance measures for the centers, counselor service expectations, and processes for oversight and monitoring so that we are describing DHCS's monitoring and oversight role, and centers know what to expect and what performance they need to deliver. So, critically underscoring that our current nine eighty eight centers will continue receiving funding from the nine eighty eight Fund until the 12/31/2029 deadline to have achieved designation.
So after 12/31/2029, centers that receive funding will need to have that designation. But between now and that date, the existing centers may continue to function and receive funds. Also noting that we will be then publicly posting the results of this process beginning 01/01/2028. So we will list nine eighty eight centers that are in operation, all centers that have obtained designation, and any corrective action plan suspensions or revocations that we might have to issue based on the standards and monitoring process. So to complete this work of designating centers and also to address the growing operational demands of the nine eighty eight system, DHCS has submitted our corresponding budget change proposal, or BCP, requesting a program certification consultant, additional DHCS staffing and resources to support this work in statewide oversight, and then also requesting direct local assistance for the existing eleven nine eighty eight crisis centers.
We note that we have consistent increases in call, text, and chat volume, and so that really points to the need for consistent statewide processes and then consistent system capacity support. So the BCP specifically requests funding from the AB nine eighty eight fund to manage the complex and growing workload associated with DHCS's administrative responsibilities, including support of the new designation process. And our request includes First Local Assistance Expenditure Authority of 19,460,000 Annually, this is in addition to the existing 12,500,000 we have in ongoing authority. These local assistance funds are for direct support of nine eighty eight crisis center operations from fiscal fiscal year 'twenty nine-'thirty. So then on the state side, we're requesting $3,000,000 annually, and that is to continue contracting with a nine eighty eight administrative entity in fiscal year 'twenty six 'twenty seven and ongoing.
We're requesting $2,000,000 annually between 'twenty six, 'twenty seven and 'twenty nine, 'thirty, for a program certification consultant to help us, stand up and initially launch this designation process. And then, finally, we have amounts of $1,400,000 in fiscal year 'twenty six-'twenty seven and then $1,370,000 in 'twenty seven-'twenty eight and ongoing to support eight permanent positions at DHCS that would manage the designation process and ongoing September workload. So we do need these resources to be able to implement the provisions of the TBL, including the designation process, and to perform ongoing statewide oversight of
Speaker 12
centers. Again, we also continue to emphasize and you'll hear from some of our nine eighty eight center partners momentarily that this local assistance funding is critical to ensure that the nine eighty eight system has capacity to manage the growing volume of calls, chats, and texts, and to avoid delayed crisis response. So I will, go ahead and shift to talk a little bit about the mobile crisis trailer bill and then also the questions that were included in the agenda. So to set up the mobile crisis trailer bill, I want to provide brief background to help explain why we're advancing this language. Under the Federal American Rescue Plan Act, or ARPA, states were given a five year window, 04/01/2022 through 03/31/2027, to offer qualifying mobile crisis services and receive an enhanced federal Medicaid match, so 85% federal match, for twelve fiscal quarters of service implementation.
And that enhanced federal funding that was available through ARPA was always cast as temporary. So in California, we were able to access that enhanced match from 01/01/2024, through 12/31/2026. Our state statute that originally authorized the mobile crisis benefit sunsets on 03/31/2027, and that was intended to align state law with this five year limited federal authority. So we are proposing this TBL to provide ongoing authority for the benefit beyond the sunset date. This would be at county option.
The TBL also would enable us to redesign the benefit framework for community based mobile crisis response services. And all of this would be effective 04/01/2027, when the current statute sunsets. So because the enhanced federal match expires at the end of this year, December 31, the TBL does propose to continue the benefit as optional by county, with counties no longer universally required to provide the service. That means that counties that choose to opt in will be responsible for the non federal share of costs without relying on general fund support. Mentioned that the TBL also provides flexibility to adjust the benefit design.
The reason we're asking for that is, you know, beginning in 2027, our coverage for the benefit is no longer tied to some specific federal requirements that were attached to that enhanced match. Those federal requirements did establish a very high bar for states to offer statewide coverage that is available twenty four hours a day, seven days a week, three sixty five days a year, no matter how rural or remote the area might be. So any changes that we make to the benefit definition would occur in consultation with our stakeholders. And the primary area that we have heard about and will consider updating is that requirement for twenty fourseventhree sixty five availability, which we recognize can be particularly challenging in our rural areas that have very low response volume. So for counties electing to provide the benefit, DHCS will continue to oversee and enforce program requirements and collect data to ensure consistency and quality.
And panning out a little bit, you had a question about the crisis continuum. So want to acknowledge that the nine eighty eight system and the Medi Cal mobile crisis services benefit are key components of a broader crisis behavioral health continuum and a broader behavioral health continuum, where we are trying to improve timely access to appropriate crisis support, strengthen coordination specifically with local crisis services, and connect individuals to appropriate follow-up care in their own communities. We are committed to building and maintaining a crisis continuum that can realize a vision where individuals have someone to contact. So the contact point is 988. We want them to also have someone to respond when they need help, and that would be our mobile crisis teams or other forms of timely crisis intervention.
And finally, we want people experiencing crisis to have somewhere to go, including crisis stabilization and then our full continuum of community based treatment services. So we recognize that supporting this crisis continuum and really giving people that timely access to care requires strengthening the connection between mobile crisis services and the 988 system, especially as the state looks to leverage the 988 funds to support mobile crisis where appropriate. So I think you are all aware that under AB nine eighty eight, mobile crisis services that are accessed through calls, chats, or text to 988 may be eligible for reimbursement from the nine eighty eight fund. We have not done that yet. And you asked whether we will have or will have a method to identify and reimburse those mobile crisis encounters that are initiated through nine eighty eight.
We do not currently have that, but that is something we anticipate developing, an approach to identify those specific responses. And that is consistent with the framework outlined in the 09/1985 implementation plan. Our September in crisis strategy also emphasizes strong partnerships with other departments, and that includes regular collaboration with the California Governor's Office of Emergency Services, or CAL OES. DHCS meets routinely with CAL OES to coordinate implementation of the September suicide in crisis lifeline and the broader crisis system, while also reviewing the operational needs of our centers understand and support their funding needs. So DHCS works closely with Cal OES on matters related to the nine eighty eight surcharge to try to ensure the departments stay aligned on our understanding of funding considerations and can support long term sustainability of the nine eighty eight network.
Cal OES does ultimately hold the authority to establish the surcharge, so DHCS is in a consulting and informing role. Regarding the transition of Medi Cal mobile crisis services to an optional benefit, you all had several questions about that. DHCS has not yet completed a formal analysis of potential impacts or begun transition planning in response to specific local coverage decisions, should counties decide not to cover this at county option. We do recognize that counties differ in their capacity to support the nonfederal share once the enhanced federal match and general fund support ends. Counties also differ widely in their service capacity, demand, and other factors that might influence their decision making, and so it is really too early to determine what disparities might emerge and which counties will opt in or not opt in.
I do want to really applaud counties' commitment up to now to investing in and launching these services. And so, given that investment to date, we do hope to see many counties continue the benefit. The Department will collaborate closely with counties to determine their plans going forward. And, of course, we want to ensure that adequate capacity exists to continue delivering timely crisis care. Last note on this counties are required to provide other behavioral health crisis services, such as crisis intervention.
So we do hope that these existing statewide crisis services can continue to support ongoing access to care, even in the event that counties opt out of the mobile crisis benefit specifically. Right now, to support a smooth transition, DHCS is reviewing the benefit requirements to understand where adjustments or additional supports could encourage more counties to opt in or make it feasible for them to continue. At the same time, we are assessing training assistance strategies and certainly welcome feedback on all this from our county partners and our providers and some of the folks you have on the panel. So we really will continue working closely on this to try to anticipate challenges, promote consistent implementation, and help minimize disruptions.
Speaker 15
Sabrina Adams with the Department of Finance. Some of the questions in the prior panel sort of addressed the budget deficit, and we really appreciate the continued partnership and the collaboration of this committee to address that $22,000,000,000 projected deficit and develop a sustainable fiscal plan that supports and serves the programs in our state. I won't sort of get into a lot of the comments that my colleague at Department of Health Care Services mentioned in her remarks, but just noting that the proposal to recast mobile crisis services as an optional benefit really sort of takes into consideration the expiration of that enhanced federal match and the broader structural deficits that the state is facing and really sort of sees this approach as a sustainable path forward, just given those broader budget considerations. So, yeah, you.
Speaker 1
Trying to collect all my questions here. How much right now is the current surcharge?
Speaker 14
Per Yes. It's 5¢, and it's on a calendar year basis. So for 2026, it's 5¢.
Speaker 12
Yeah. In the statute, that is obviously the direct operations of the nine eighty eight response centers and then mobile crisis qualifying mobile crisis responses, which we mentioned need to be those that were routed through nine eighty eight. And then there is state administrative responsibilities that can be covered today.
Speaker 12
Yeah. To your earlier question, and then I'll let Ivan chime in if I missed anything about the way the statute is structured, we can identify a mechanism to know or identify which mobile crisis responses originated through September. And once we do that, the statute would allow us to use the September fund, too. Sure.
Speaker 1
So TBLs have amended statute many times. Is is is it a option? I'm not saying. I'm just saying is it allowable to further define what kind of mobile units could be eligible to get funded under September surcharge?
Speaker 11
I would just like to point out that happy to work with your staff, but also would like to point out that any type of TBL expanding that may also need to be looked at conforming changes within the statute that allows OES to what they factor into setting the surcharge amount.
Speaker 1
Okay. Thank you for that. And will we need to increase the surcharge with the request that is being asked in this BCP, or is the current fund cover what is being asked
Speaker 1
Okay. But you wouldn't I think you would need to know, right? If you're asking here in BCP, you would need to know if you have the funds, right?
Speaker 15
Yeah. So in statute, the statute outlines that Cal OES sets the by October 1 of each year. And Cal OES uses a statutory calculation to sort of consider the fund balance that's existing in the fund and sort of what the authorized expenditures are for the following for the fiscal year, and they set the fee so that revenues are generated to support the level of authorized expenditures in the Budget Act. So, like, depending on sort of what is authorized Mhmm. In the 2026 budget act, there could there could be there could yeah.
There in October, there could be a need to adjust the fee, but it would be in accordance with what's approved Okay. Through the budget act. Since you're in
Speaker 1
a consultation relationship, has there been consultation with Cal OES, given that this BCP is being proposed?
Speaker 12
Doctor. Yeah. And, Ivan, you may want to elaborate. But I think we do regularly share information about the identified costs of the nine eighty eight center, right, which is what informed the estimate and the specific amount requested in the BCP. So we'll continue to communicate about that with Cal OES as we proceed.
Speaker 1
Okay. I'd be really interested in a more direct answer, if you can share, in the consultation, is there already in anticipation of an increase in surcharge to cover this BCP? I would have anticipate I wouldn't hope to know that CalES would have understanding if the current funds covers it now or if we would have to increase the surcharge into what we would have to increase should this BCP pass. If you can get me that information, shortly after this, that'd be helpful. Deputy director deputy director.
Yes. Deputy director. You in your response to number two, you you shared and I get it. That's in conjunction to what, department of finance responded to. But you shared the language you met you said it's like we're in commitment.
We're we are fully committed to the two pieces, someone to contact and how will someone respond to them. Step two is crucial. It's that's a bit of a dissonance there that we're in commit we're committed to this, but we're not in further investing into step two. Step two is a crucial part of what you're the department is saying that they're in commitment to. So disconnect there, I'm feeling.
I think it's hard to say we're fully committed to this, but we're no longer gonna make this a fully covered benefit. And step two, I think, like I mentioned, is a crucial part to getting the continuum of care. I think we're fracturing the continuum of care here. I'm also wondering how we look at a $150,000,000 investment in the non bond b chip for round one went into the infrastructure of this. Are our taxpayers now gonna say it's a waste of money because we invested to create an infrastructure that we're no longer gonna fund?
Is that looked at as a waste?
Speaker 12
Yes. I think I really understand and appreciate those concerns and would refer back to what my colleague from Department of Finance said, which is, these decisions are made sort of looking across budget and spending priorities. And this is the proposal at this time. DHCS certainly is committed to working with counties to figure out what are the avenues for both continuing these services and then strengthening the additional crisis response services that we mentioned that will continue to be required under Medi Cal so that we can maximize whatever resources we can.
Speaker 1
Would you be able to respond to the principal question, the core question of, the state invest in an infrastructure of XYZ program? For us to cut it at the knees, regardless we don't have to talk about the mobile crisis unit, but regardless of what program, Is that a waste of investment then? We've invested so much money into creating uplifting and infrastructure to not fully continue with it. Department of Finance, is that a waste of our money? I'm not just talking at this point, any kind of investment we make for building infrastructure.
Speaker 12
Asking our county partners also to speak to whether or how they're able to sustain So that I think, again, we hope that they will be able to, that those were, you know, startup and infrastructure funds, that we will find ways to carry forward, but certainly under understand the concern.
Speaker 1
And I brought this up, deputy director, last hearing. We are not absorbing a single thing that the federal government cut from us, not one thing. And we want the county to absorb everything we're kicking them off. I just wanna make that clear that everything that is sub three, we have said no to funding that the federal government cut from us and are hoping the county will continue all of it. And we haven't taken on a single thing that the federal government has cut from us.
That's, again, a bit hypocritical from us to say, I think you can do it, county, but we're not doing a single one of them. It's just it's hard to say, county, I need you to be a partner with us when we haven't taken on and not just in your department, madam. It's just overall in sub three. It's hard for me to say, county, do it all, when we aren't coming to the table and saying we're gonna do part of it. So that's just an overarching theme that I've seen this year under sub three.
Back to my questions. Can I get clarity on the funding was until, I said, 03/31/2027 for the mobile crisis, but it ends this year, the funding?
Speaker 12
Yeah. There are two dates, and it is a little confusing. So the enhanced federal match for the mobile crisis benefit is available through the end of the calendar year. So that ends in December. But the statute that originally authorized the benefit sunsets at the March because the way the federal legislation was written was there was a five year authorization period.
And then there was also is it 12 quarters of enhanced federal match, which states could be on slightly different timelines depending on when they launched the benefit.
Speaker 1
Okay. Okay. Thank you for that. And then how much I was trying to find the dollar amount. So it's 85% match from the federal government.
How much are we putting into it?
Speaker 12
Historically or potentially going forward? Historically Sure. Under the Yeah. Would need to defer to Department of Finance for that.
Speaker 15
So the 2022 Budget Act authorized one time funding of $1,400,000,000 general fund over five years for mobile crisis
Speaker 1
$1,400,000,000 over five year, whatever that math is. Okay. And we have funding until December. Is there any numbers of how much to fund until I'm curious. I'm just curious if you can get back to me.
That's half of the fiscal year. Is there the amount it would cost to fund it until June 30?
Speaker 12
So we have, in the current budget, assumes the enhanced federal match continues through December. And then there is a three month period until that March 31 state where the budget proposes use of nine eighty eight funds.
Speaker 1
does propose. I apologize. So it does propose so that's where I'm getting the April?
Speaker 12
Yes. And then, technically, you know, without the TBL, the benefit would sunset as of April 1. Okay.
Speaker 1
So then how much is it for the three months? Do we have numbers of how much it would cost to fund for the last three months of the fiscal year? Two months, I guess. May and June. And if not, Nawa, if you could share.
Speaker 1
And then on the crisis centers, a couple questions to see if I understand this correctly. Is it that the crisis centers or so the crisis centers support their total funding needs for operation is a 105,000,000? Do they feel like they're underfunded? Because then the department says you have 12,500,000 local assistance appropriation for the centers, but the centers say their operations are 105,000,000?
Speaker 14
So our current funding request is based on current capacity. And I believe what their funding request is inclusive of is being able to target greater answer response rates across calls, chats, and texts.
Speaker 1
So they're saying that they're we don't they don't have the capacity to meet all the need?
Speaker 14
They have the capacity. So our funding, again, is consistent with what their their current capacity is. Okay. And what they're suggesting is essentially to grow to meet the growth volume over the next, fiscal year, and also to be able to meet answer rates at target rate that is expected from SAMHSA, which is greater than 90. Their funding request would be consistent with that.
And also their response times. So right now, SAMHSA mandates that across all contacts, so chats, texts, and calls, the answer response rates have to be greater than 90% for fifteen seconds, so responding within fifteen seconds, and then 95 would be twenty seconds.
Speaker 1
Okay. So they would like to be able to meet EMSA's requirements or SAMSA's, yeah. Guidance? Exactly. Oh, SAMSA's, sorry, guidance.
But the workload has workload has still increased for the BCP need of the positions?
Speaker 14
Correct. Exactly. Okay. And our funding request takes more into account. What was that?
Our funding request also takes into account a little bit of that growth. And so we're providing more funding than we have in the past.
Speaker 1
Okay. So the funding increases because of their growth, but they haven't grown to the point where it's at the full SAMHSA guidance?
Speaker 1
Okay. And will the positions allocated here help them grow to that level?
Speaker 14
The funding so the positions that we're requesting are for state operations. So those are for DHCS. And then the local assistance funding, which is about $19,460,000 plus the $12,500,000 in ongoing costs, that's specific to the centers. And that, again, is intended to meet their current operational capacity.
Speaker 1
No, but I guess I know the positions for the department, but would those positions help them meet their full growth?
Speaker 12
I think the positions will help us stand up and implement the designation process and also do the ongoing quality monitoring. So I think those positions will help us do things like identify that process to monitor mobile crisis encounters, right, that result through September. It will help us monitor their performance on the indicators that Ivan just talked about, give us better data and better oversight effectively. Okay. And then why I'm
Speaker 14
There is a regional center, Didi Hirsch, that supports the Los Angeles area.
Speaker 1
Okay. This okay. Yes. Century City. There we go.
Thank you so much. Let me switch to seeing counties. That's why. Okay. And then my other I think my last questions are is, deputy director, like, what do you anticipate or what do you anticipate will happen if the Mongols crisis units aren't funded?
Speaker 12
I think what, you know, the best case scenario, right, is people and communities are resourceful. And there have been, over the years, other investments in mobile crisis response through EMS, through law enforcement, etcetera. We do have a lot
Speaker 12
It's not interchangeable. Thank you. Yes. So to answer your question, I mean, I think we would hope that there will be ways to continue funding this response. And we will also need to look, as mentioned, at other crisis services and continued investment in those services.
And we will need to monitor, right, are we seeing performance indicators that are concerning increased use of other crisis services, increased hospitalizations, etcetera. And those are the kind of things that the state can take into consideration in the future as we look at how to prioritize funding and where to invest in our system. Okay.
Speaker 14
And also just noting that for those counties that do not opt into the mobile crisis benefit, they would still be able to continue to bill crisis intervention services.
Speaker 1
Okay. Thank you. The last thing I would note is I keep saying this, we do all these plans and we don't turn to them. CalHHS, we did a plan, the building California's comprehensive nine eight system, a strategic blueprint, to tell us how successful we can be. And that's one of the recommendations.
Mean, we tell ourselves how to be successful, and it's we don't follow through with it. You know? It's to reduce unnecessary law enforcement involvement where possible and connect it to a crisis care continuum. I mean, those are two of the four plans that we said that we wrote into this blueprint. So if there's a way I mean, I'd be really interested on the surcharge.
I know the general I get we can't turn to the general fund. I get that. Like but if there's opportunities where we can turn to a surcharge, we have 25¢ left in the increase that we can go to. And if there's an avenue that we can turn to, not every program has a potential revenue stream that you can turn to. And if there's a potential revenue stream we can turn to to save global crisis from making sure it's a covered benefit, I'd love for us to look at that as an option.
Okay. Thank you so much. Oh, wait. Nope. I already asked those.
Thank you. Now we'll bring in our county partners to give shares share some insight on the same topics recovering.
Speaker 1
And the providers. Yes. So we have Lake County Behavioral Health Services, behavioral health services from the county of San Diego, Seneca Family Agencies, Sycamores, Didi Hirsch from LA, and the Crisis Support Services of Alameda County. So, we'll start with Director Jones.
Speaker 17
Oh, we are live. All right. Thank you, Chairman and Jafar. Appreciate the opportunity to speak today. Of course, you know my name is Elise Jones.
I've been serving as the Director of Lake County Behavioral Health since the 2023, which in dog years is a long time, and I joke about that. In Lake County, we're a population of about 67,500 people, 68,000, very rural, big lake in the middle of it, very hard to get around. Unfortunately, we don't have a ferry that goes across the lake at this time, although that was an idea of our mobile crisis team. We currently operate one county operated mobile crisis team. We are on staff twenty fourseven, three sixty five days a week.
That is a team of a minimum of two people responding. We also have our own dispatcher, if you will, to route calls. In calendar year 2025, we received approximately five thousand six and sixty four crisis calls, and we conducted thirteen oh five field responses. About 83% of those field responses were resolved safely in the community without needing a higher level of care. That means people were stabilized through de escalation, clinical assessment, safety planning, linkages to services, and follow-up without defaulting to emergency department, hospitalization, or law enforcement response.
We did receive $1,000,000 in the crisis, the B CHIP Crisis Care Mobile Unit grant, and that was critical for us. It allowed us to purchase two vehicles, support staff salary prior to being able to draw down reimbursement, conduct public outreach, and for the first time ever, our department actually was able to put up a couple billboards to spread the word, which was great. I want to be careful about the definition of mobile crisis. Mobile crisis is not just the moment that the team arrives in the field. Under DHCS guidance, it is a clinical crisis intervention that includes assessment, de escalation, mobile response when appropriate crisis planning, warm handoffs, referrals, and follow-up.
If we wait until somebody meets 5,150 criteria or is already at the highest level of acuity, we have missed the opportunity for Mobile Crisis to do its job. This is also why 988 integration matters. 988 is an important front door, but it does not replace the local response system behind it. In Lake County, 988 calls are routed through our contracted crisis line and triaged for response with escalation to mobile crisis or law enforcement when needed. But we continue to see rural challenges, low and inconsistent 988 call volume, geo routing issues with smaller carriers, limited data visibility, and gaps in coordination between 988, 911, and local mobile crisis.
We are also concerned that mobile crisis may increasingly be used for only higher acuity dispatches. That would undermine the preventative role of mobile crisis and make the system more reactive. The broader budget context matters. The agenda recognizes that California is investing in nine eighty eight crisis centers while also proposing to repeal the statewide mobile crisis benefit and transition it to a voluntary, county funded service. That is strengthening the front door while weakening the response system behind it.
At the same time, the State continues to invest in the deepest end of the system, including state hospitals, which we heard from earlier today. I understand those investments are critically necessary, and yet hospitals represent the end of the treatment line of continuum. If we cut or destabilize upstream crisis response, we should expect more downstream costs: more emergency department use, more law enforcement involvement, hospitalizations, more conservatorship pressure, and more demand on state systems. For Lake County, shifting mobile crisis to county responsibility would create immediate sustainability risk. In short, we could not afford this, and we would have to divert back to pre mobile crisis days where we only respond to 5,150 calls when needed with a very limited designation.
It's also notable that the rate that's being referenced by DHCS for that specific service is much lower than the rate for the mobile crisis benefit. So Lake County's request is simple: maintain statewide support for mobile crisis, strengthen 988 to mobile crisis integration, and support rural flexibility, which does not preclude like you can still have this benefit with flexibility. But saying that you hope counties will continue this benefit in the absence of a requirement, I cannot pay bills with hope. Thank you very much.
Speaker 1
Thank you so much, Director. Now we have the Director from the County of San Diego's Behavioral Health Services.
Speaker 4
Thank you for having me here today. My name is Nadia Prevara. I'm the Director of County Behavioral Health in San Diego. In 2019, our clinical teams worked with our sheriff, district attorney, and other stakeholders to develop our mobile crisis response model. We all saw the urgent need for responses tailored to people in crisis to improve care pathways and reduce law enforcement involvement and emergency department utilization.
In 2021, our first two mobile crisis teams started only in our North Coastal region of our county. Later that year, we saw the early success of the program, and we were awarded 18,000,000 to of b chip funding, to add 18 additional mobile crisis teams and expand our services countywide. The mobile crisis service also became a Medi Cal benefit, signal signaling to us the state's commitment to sustaining these life saving services. Locally, we took the opportunity to continue expanding the services into our k through 12 schools, colleges, and to universities. And over the last eighteen months, they have responded to over 600 calls on school campuses to support children in crisis and connect them to ongoing care.
Without these teams, law enforcement would have responded, which often escalates and stigmatizes students. Our teams are also building rapport and responding now to tribal communities. We now have 44 mobile crisis teams, which are primarily funded through Medi Cal State General Fund at a cost of $24,000,000 a year. About 85 is covered, as, they mentioned, through Medi Cal, with the other 15% covered through State General Fund. We also cover, costs for uninsured clients, who use the services as well.
Since inception, the teams have responded to more than 32,000 calls, with 98 receiving a response in less than one hour. Mobile crisis teams are essential with when our children, neighbors, and loved ones are experiencing a psychiatric crisis. The clinicians and peers are skilled in de escalating crises in the field, with only two percent requiring law enforcement intervention. Half of all calls that we receive, at in a field intervention are stabilized in the field. And our program is focused on supporting Medi Cal beneficiaries with over eighty percent of the clients being Medi Cal eligible.
Mobile crisis services are also an entry point into the system. Nearly sixty percent of people served through these crisis services receive a behavioral health service within, thirty days. Additionally, they also can determine if somebody meets, involuntary hold criteria with about sixteen percent of interventions resulting in a fifty one fifty hold. But the community benefit is so much larger. Over 80% of the encounters are diverted from costly emergency department visits.
Our law enforcement partners benefit as well. About 18% of the mobile crisis referrals are diverted from law enforcement intervention. So law enforcement officers instead are be able to respond to real emergencies. Twenty twenty two, we have also leveraged the 988 crisis line to support mobile crisis response. Community members can dial 988 and connect with our local access and crisis line, which works directly with the mobile crisis teams to dispatch services.
Our teams are truly integrated within our local network, delivering efficient, compassionate, crisis care to people where they are. So what happens if the mobile crisis team becomes optional and county lose counties lose state funding? In San Diego, it'll force us to significantly scale back our crisis teams impacting our entire system. With the shift of Medi Cal percentage from 85 to 50, we will lose revenue of approximately $15,000,000 a year, including about $10,000,000 in Medi Cal and about five and a half of, state general fund dollars. And the impacts of HR one, when those begin to hit, there will likely be additional uninsured individuals that also use our mobile crisis teams as their benefits, are lost.
Our county cannot absorb these costs and maintain the existing capacity. Making the optional benefit optional moves our system backwards. It'll undo the progress we've made to improve access to care and reduce barriers. It will undo the crisis services that support our schools when we know mental health concerns are drastically increasing. It will undo our efforts to reduce unnecessary law enforcement involved, contacts, likely increasing adverse interactions and potentially abandoning people in crisis when calls go unanswered.
It'll also undo our progress to decrease unnecessary use of emergency departments, and it's going to impose new strains on our already burdened system by increasing the use of our own crisis stabilization units and crisis walk in clinics. Mobile crisis teams are a regional asset and argue arguably the most effective behavioral health intervention that we've implemented in recent years. Over the last five years, we've been a leader in implementing these teams, and they are fully integrated into our system. They should be prioritized as a Medi Cal mandated Medi Cal benefit with state general fund and Medi Cal dollars. So we hope that these won't be sustained long term.
Thank you for your time today.
Speaker 1
Thank you so much. I'll go to Chief Strategy Officer from Foundation of Agencies. Good afternoon, Chair Menjivar.
Speaker 8
My name is Emily Allison, and I serve as Chief Strategy Officer for Seneca Family of Agencies. Seneca is a nonprofit that has helped children and families through the most challenging times of their lives for more than forty years. We provide comprehensive behavioral health, education, and child welfare services across 19 counties in California. One of the most crucial ways we do this is through our mobile response services in three counties, which responded to over 1,400 crises by phone and in the community last year alone. For over twenty five years, our mobile crisis teams have helped young people and their families navigate profoundly difficult moments.
We were there for Anna, an 11 year old foster youth whose grief, loneliness, and separation from her family had become so overwhelming that she began talking about wanting to end her life. Working with Anna and her resource parent, our bilingual clinicians helped stabilize the crisis at home and created a plan to support her safety and connect her to ongoing care. Our team responded to Nina, an eight year old girl whose trauma from witnessing extreme domestic violence was triggered during the school day, leading her to hide under a desk, scream, and strike out when adults approached. Using play, patience, and trauma informed support, our team helped her feel safe enough to reengage and worked with caregivers and school staff to plan to reduce future crises. And we were there for Damian, a 13 year old foster youth whose caregiver feared the placement was about to disrupt after repeated nighttime conflicts, threats to run away, and escalating emotional distress.
Our team helped de escalate in the moment, supporting both Damian and his caregiver, and built a plan that made it possible for him to stay safely in the home while his child and family team developed a longer term plan. I'm here today to advocate for kids like Anna, Nina, and Damian, and to strongly urge the legislature to reject the proposal to make mobile crisis an optional benefit. This vital service connects young people in crisis with teams of highly trained professionals who can respond in the community, de escalate safely, and connect youth to the care they need. Children are not just small adults. Their crises are different, their developmental needs are different, their family dynamics are different, and their service systems are different.
Guidance from SAMHSA and the American Academy of Pediatrics clearly states that effective response for children requires specialized teams that understand youth development, caregiver and family engagement, school and child welfare systems, and how to stabilize a crisis in a way that protects long term well-being. If this benefit is made optional, counties will have a much harder time sustaining specialized children's teams, let alone with 20 fourseven support. And in many places, especially rural counties where these services are needed most desperately, mobile crisis teams may completely disappear. That would be a devastating loss. We should be moving towards more community based, specialized, and developmentally appropriate crisis response for youth, not away from it.
This proposal would also have a direct impact on foster youth who receive mobile response services through the Family Urgent Response System. Last year, 23% of Seneca's mobile response services were provided to FERS eligible foster youth and former foster youth. Seneca is the FERS provider in the counties where we provide mobile response. This is not coincidental. The integration is what makes the model work.
FERS funding on its own is not sufficient to sustain the infrastructure and staffing required for 20 fourseven community based crisis intervention. If mobile response is made optional, FERS will be impacted, too. For foster youth and caregivers, that will mean less support in critical moments when a young person's placement stability is at risk. We know that mobile response works. It's a proven prevention strategy.
In Seneca's longest standing mobile response program, we stabilize 86 of young people who receive an in person visit, diverting them from a potentially traumatic ER visit, inpatient psychiatric care, or law enforcement contact. We also provide follow-up support, connect youth to ongoing services, and help them step down from higher levels of care, often for thirty to sixty days following the initial crisis or referral. This is one of the most important prevention tools we have, reducing reliance on settings that are more restrictive, more disruptive, and more expensive. Cutting mobile crisis response does not eliminate crisis. It just shifts the cost and management of behavioral health crises to county systems who are already struggling with the financial constraints already discussed today.
It also shifts the cost and management to resource stretched law enforcement agencies and emergency rooms that are designed to address acute physical health crisis. California has made such extraordinary progress building out this critical part of our community based crisis continuum, and we cannot go backwards now. I respectfully urge the legislature to reject this proposed change and maintain the statewide mobile crisis benefit. For young people and foster youth in particular, mobile response is not optional. It's one of the most effective and important programs we have in California.
Thank you.
Speaker 1
Thank you so much. Doctor. Lord? Great name. From Sycamores.
Which I did a visit two years ago.
Speaker 9
Yes, you did. We loved having you. Chair Mengevar and subcommittee members, my name is Doctor. Jana Lord, and I'm the Chief Operating Officer of Sycamores. I oversaw the launch and sustainability of the nine eighty eight Mobile Crisis Response Services in Los Angeles and Riverside Counties, as well as the establishment of unarmed community crisis response programs through contracts with other municipalities.
I also serve on the Health and Human Services Agency nine eighty eight Crisis Policy Advisory Group. For one hundred and twenty four years, Sycamores has been committed to the well-being of children, adults, families, and communities throughout Southern California. In fiscal year twenty four-twenty five, Sycamores served over 37,000 individuals across our programs in two counties. Sycamore's nine-eight-eight mobile crisis teams are responsible for the majority of Los Angeles County, with 19 teams that operate during the week from four p. M.
Until eight a. M. And twenty four hours on weekends and all holidays. In Riverside County, as a sole mobile crisis team nonprofit provider, Sycamores is responsible for calls across the entire county from six p. M.
Until 08:30 a. M. The proposed elimination of the Medi Cal statewide mobile crisis benefit threatens California's immense progress to transform the behavioral health continuum. The success of the 988 suicide and crisis lifeline can be understood through this framework, as we've talked about, right? Someone to call, someone to respond, and somewhere to go.
If the second pillar, someone to respond, is significantly depleted, which we anticipate will happen under any county opt in Medi Cal model. It threatens the stability of the statewide nine eighty eight ecosystem. The Medi Cal Mobile Crisis benefit provides community members with critical stabilization, life saving services and supports during moments of behavioral health crises. Community members can access a local mobile crisis team through two primary pathways. The first is by calling 988, where a counselor may determine that mobile crisis team is necessary to a caller's safety.
The second pathway is by calling the county's direct access or crisis helpline, which can also dispatch a mobile crisis team. Mobile crisis services are vital to reduce unnecessary law enforcement involvement, unneeded emergency room visits, and to minimize the number of persons placed on involuntary holds or inpatient hospitalizations. Emergency rooms are already overwhelmed with patients and anticipate additional volume due to federal HR1. The mobile crisis teams that we offer are comprised of two members. We have a licensed practitioner and a peer support with lived experience.
The Sycamores teams deescalates emergencies in the community by providing crisis assessments, clinical interventions, and they develop a safety plan with a member and their family. Our teams also offer post crisis follow-up within forty eight hours after the in person encounter to all community members. This is to ensure that all barriers for follow-up care are removed. From 07/01/2025, through March 31, Sycamore's L. A.
County mobile crisis teams responded in person to over 2,430 calls. Only 13% of those mobile crisis responses required a law enforcement presence, and approximately 9% were unhoused. We want to highlight that fifty eight percentage of our total field responses across the entire L. A. County led to hospitalizations, generating a significant savings to the health care system, and we helped to decompress hospitals' emergency waiting rooms.
For the San Fernando Valley, that includes the 20th Senate District, our nine eighty eight Mobile Crisis teams responded to about seven ten calls, of which fifty two percent required hospitalization. In Riverside County, Sycamore's data reveals similar trends, yielding strong outcomes. During the same time frame, our mobile crisis teams conducted seventeen twenty three in person crisis assessments. Only nine percent required law enforcement assistance to ensure the safety of both of our community members as well as our staff. And thirty three percent of our total calls resulted in a hospitalization, a psychiatric hospitalization.
To be clear, the proposed elimination of the statewide Medi Cal mobile crisis benefit and to shift to a county opt in model will worsen the availability and the response time of these services across all of our communities. This will exacerbate existing inequities and shift the cost to counties and the broader health care systems. In closing, I wanted to share a story about how our mobile crisis response services help someone in distress. This is Sarah's journey towards recovery, from cyclical crisis to stability. A crisis evaluation was requested for Sarah, a 36 year old woman, after an argument with a family left her feeling like a burden.
In a moment of despair, Sarah ingested pills and called an ambulance, expressing that she didn't want to cause further trouble for her loved ones. Sycamore's mobile crisis teams immediately worked to ensure Sarah's safety by coordinating a hospital hold so she could receive a thorough medical evaluation and treatment. The team recognized that her elderly mother, Elena, was deeply affected and had her own history of mental health challenges and was overwhelmed by fear of how to help her daughter. The Sycamores Mobile Crisis peer support specialist advocated with Sarah's treatment team for a higher level of care, recognizing that Sarah had been cycling in and out of psychiatric hospitalizations without any lasting improvement. The peer support specialist also linked the mom, Elena, to her own mental health resources.
For a family that has faced years of emotional hardships and repeated, costly hospitalizations, Sycamore's Mobile Crisis Team's compassion, persistence, and advocacy offered something that this family long needed: hope. Both Sarah and Elena have expressed gratitude for a team that treats them not as a case, but as people worth patience and care. Thank you for this opportunity to testify.
Speaker 1
Thank you so much, Doctor. Dorr. To my last speakers you do have a drawing time. Okay. Thank you so much.
We'll start with the senior director at D. D. Hirsch, Matthew Taylor.
Speaker 10
Thank you very much, Chair Menjivar and other members of the committee watching remotely. My name is Matt Taylor, and I'm the senior director of crisis line operations at D. D. Hirsch Mental Health Services based in Los Angeles. We are home to one of the largest nine eighty eight centers in The United States.
Last year, we responded to and provided compassionate care to over 250,000 Californians in crisis. Every hour of every day, Didi Hirsch and the other ten nine eighty eight centers in the state of California answer calls, chats, and texts from Californians who are in their darkest moments. I know what crisis sounds like. I know what it feels like to reach out for help and to get a response that makes matters worse. In 1995, I was suicidal.
There was no nine eighty eight. There were no mobile crisis teams. When someone called out for help on my behalf, the only response that was available were the police. I was in a very public place. A group of officers arrived.
I was surrounded. The situation quickly escalated. I ran towards a bridge over a river. I wasn't actually planning to jump off that bridge. I just wanted to get away.
The officers chased me, tackled me, brought me back to the place where they first met me. They shoved me to the ground. They put handcuffs on me. I remember the look of the concrete. I remember seeing the shoes of my friends who were watching and the public that was also watching me.
Meanwhile, I was sitting there sobbing, I'm not an animal. What I needed at that moment was calm, clear, compassionate care that maintained my dignity and my privacy. I was not treated as a person in a medical or mental health crisis. I was treated as a problem that needed to be contained. I was taken to the back a squad car to the local ER where I sat for quite a while.
I actually walked out of the ER, wandered around a few city blocks, somehow composed myself, walked back to the ER, went back to the room. Nobody even knew that I was gone. After a short while, I had a quick assessment and I was discharged without a single connection to ongoing care. If there had been mobile crisis available, then I might have been able to stay safe at home that earlier that evening. The situation likely wouldn't have escalated as it did.
I also firmly believe that I would have been connected to a therapist and to the medications I needed at that time. Mobile crisis teams fundamentally changed the experience of people, just like I described, that I experienced. Mobile crisis teams are the clinical bridge between a phone call and appropriate treatment. They free up law enforcement's time. They reduce emergency department overcrowding.
And they give the people in crisis a chance to get through that moment safely and with dignity. Eliminating predictable statewide funding for mobile crisis teams and somehow hoping that counties will be able to pick up the bill, that is an action that places all Californians at risk, but especially communities that are very rural and who aren't as affluent and maybe where the counties can't actually really financially support those mobile crisis teams. Final thoughts, Mr. Taylor. Yeah.
So the crisis continuum has three essential components: someone to call 988, someone to respond to mobile crisis teams, somewhere to go such as crisis stabilization units. These are not interchangeable. Remove one and the system fractures, the stool falls. Remove one and more people fall through the cracks. In closing, if statewide funding is eliminated, then the legislature is not trimming a budget line.
Instead, they're removing the middle of a lifeline and cutting a hole in a vital public safety net. Thank you.
Speaker 1
Thank you. All right. Our final speaker is the ED from the Crisis Support Services of Alameda County.
Speaker 18
Thank you. Good afternoon, Chairman Njavar. Thank you for your attention to the sustainability of California's nine eighty eight system. My name is Nargis Zohri Dillon, and I'm here as the president of nine eighty eight California, the 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.
Our centers provide 20 fourseven telephone support as well as text and chat services for Californians in their moments of crisis and worry about a loved one. Since the transition to September, the number of help seekers reaching out to us has consistently increased. Comparing January 2025 to January 2026, the incoming call volume to California's nine eighty eight centers increased by more than 37%. During the same period, the text and chat volume increased by 26%. Our counselors don't just answer the phone.
They provide in the moment de escalation, suicide risk assessment, safety planning, direct links to the 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, and that's why we want to ensure that anyone who reaches out gets that consistent, compassionate care. According to SAMHSA, users feel less depressed, less overwhelmed, and more hopeful after speaking with a counselor.
And just last week, JAMA, the Journal of American Medical Association, published a study that found that 988 is working, with few suicide deaths ages 15 to 34 dropping eleven percent below projections. This study linked the largest declines in state with the highest call volume. Despite the rapid growth and proven impact, our centers are facing significant financial shortfalls that's impacting our ability to increase our capacity to meet the demand. Currently, just over 40% of text and chats from California help seekers are being answered by our centers because our funding has not kept pace with demand. Without a significant investment, we cannot meet the national standards of answering 95% of contacts within twenty seconds.
Most critically, the decrease of the $9.88 surcharge from $08 to $05 this year is extremely worrisome, considering what I just shared. AB nine eighty eight allows for surcharge of up to 30¢. This dedicated source of funding gives California a chance to deliver on the promise of nine eighty eight. At a time of numerous stressors to the broader behavioral health continuum, September is literally a lifeline. By de escalating crises, we prevent unnecessary high cost ER visits, unnecessary costly traumatic law enforcement response, and we provide the essential follow-up care for people with suicidal ideation, a proven intervention that reduces attempts.
Many of the California centers have been a part of the lifeline for over twenty years. We support the state's five year nine eighty eight implementation plan, but cannot achieve the comprehensive continuum of care without the strong foundation of nine eighty eight Center. The DHCS BCP only adds $2,000,000 for next year to the centers directly. We urge the legislature to allocate the $105,000,000 necessary to meet the immediate need in our state's suicide prevention system and direct DHCS to create a funding methodology with input from center that accounts for growth in addition to other dynamics to providing this unique service. Thank you.
Speaker 1
Thank you so much to all of you who spoke on this topic. Who pays when the patients go to the hospital, SAC ERs? You gave some examples in my district. When yeah, they end up anybody.
Speaker 17
So, county behavioral health, obviously, you're in an ED room in the acute, like a regular hospital. For us, we have two rural critical access hospitals, real basic level of care. That's not us. However, if they need to go to an acute psych, an IMD, Institute of Mental Disease, that is ours. And those are some of our highest costs.
That's probably one of the biggest line items in our budget is those acute psych placements. Okay.
Speaker 4
There we go. So, same with us. So, it could be the hospitals that are paying for it, if they're going to the hospital. It could be law enforcement, obviously, enforcement resources for us, too, for adults, at least in our system. They end up going to we have a county operated psych hospital, the cost per bed day there is, like, dollars 3,500.
So it's incredibly expensive, and especially if there was a preventative sort of option that they could have been de escalated in the field.
Speaker 1
And counties, if I can imagine preventing it from going to these locations is more cost efficient. So isn't there an incentive for counties to fund these mobile crisis units then so you can save money in preventing them from going them there? I would say absolutely.
Speaker 4
I think this is, again, like a prevention method, but it's sort of like picking your favorite child. We have many things that we are mandated to provide, and we have to provide all those things because we must do those things. And if this becomes optional, it's sort of like weighing the things that we are mandated to do with the things that we would like to do. Yeah.
Speaker 1
Right now, there's a partnership with the federal government and the state. The state doesn't pay for all of it. There's a huge amount of it comes from the federal government. It's 85%. That's a lot.
The state can't take on the full. Sure. Put the counties in an option, put up some of that match if there would be an option to move forward to continue to fund this, but not all of it be from the state. Can have counties considered being part of that match?
Speaker 17
I think I think that that's probably happening on a county by county basis, and I think that probably CBHTA could help pull together an estimate of what is real it varies widely. Like, for example, in Lake County, I don't have the ability to tap into any county general funds. So, everything that I have, I have to either realignment, BHSA, or patient revenue, which is incredibly limited. It should be noted that counties with a lot of displacements, those come right out of your realignment, usually. So, we've seen that increasing as well, which is unfortunate.
So, we've also seen our realignment sources dwindle as a result.
Speaker 4
Okay. And for us, like as a larger county, we would have probably a bit more ability to do that. We obviously have a large continuum, 44 teams. And so I think some you know, we wouldn't be able to do the full spectrum. Right.
But I think a portion because of the, obviously, benefit, we would be able to do a portion of it.
Speaker 1
Okay. And to the providers, I spoke a little bit to the department around the infrastructure and what happens to it. What happens to the infrastructure right now should you not get funding to move forward? We talking about Anybody of
Speaker 9
the yeah. Sycamore or Seneca. If there isn't funding and that's pretty simple the teams are going to be cut, chances are we might go back to the ecosystem that we had prior to this mobile crisis benefit, in which you were able to see mobile crisis services for during working hours. And so, fingers crossed that that's when you experience And your prior to I can only speak for L. A.
And Riverside Counties there were no mobile and these are large counties, right? There were no mobile crisis teams in Riverside County that were operating PM as well as overnight. LA County, it was sparse, sparsely funded, it was only until two a. M. In the morning.
There might be, like, one or two teams. So, the reality is that the people were diverted to law enforcement. We have, I think, as a statewide, we've really tried to partner with our law enforcements, and we've had some areas of extreme success and some areas of limited success. And it depends upon who that team arrives on the scene and what kind of services and which are going to be rendered. You know, as I my colleague, Matt, here, spoke about his personal experience and what that was like.
We do frequently hear from individuals in the community in which they encounter a trained behavioral health mobile crisis team arrive on scene, Thank you. You are like angels. I've never experienced a service like this. Previous hospitalizations were from law enforcement, or they had to go into the emergency rooms and sit there for hours. Sometimes, a person is really escalating or that, you know, particularly if law enforcement comes on scene, that can quickly escalate a situation in which, I mean, quite frankly, it could turn lethal.
Speaker 8
Only to underscore the outside of business hours. Close to half of our calls come in outside of traditional business hours. And I would just add, you know, we would underscore the importance not just of generalized teams with some additional training in children and youth, but the importance of specialized teams for young people is an important value that we hold. And that would be one of the first things to go.
Speaker 1
Okay. And then Dylan, right? You started talking a little bit about, and I had a question to the department on that, on the increase of the actual cost, I think the 105,000,000, I think. Can you explain a little bit more about is that you have the capacity to do more? Or like the
Speaker 18
So kind of the equation is, in order to answer more contacts, we need more staff. Okay. And that's where the money would go. So that's what the local support category is. So if the centers get additional dollars, they can hire additional staff.
Speaker 18
We are able to see that from Vibrant, which is the national administrator. They do provide monthly reports on incoming calls as well as answered calls. For calls, the answer rate is somewhere between in the high 80s, 80% for California. For text, it's 40%. And that's actually where most of that for text and chat.
Okay. That's where most of that 105,000,000 honestly would go. Text and chats on average take about three times as long as a phone call. A phone call on average is like twelve to thirteen minutes. A text and chat is 43 to 45.
Speaker 18
Text and chat? Yeah. No. Doing an assessment on text and chat, like, for some of our youth providers, like, you ask a question. Takes a while to respond.
Yeah. Like, we're having like, and the rapport building is different.
Speaker 18
it. So as a result, it makes each text and chat contact more expensive as a modality. So that's where the worry is. And that's where most of the money would go if we get the money we're asking.
Speaker 18
as the No. More people choose to call, actually. But not all California centers had text and chat capacity when September first started. So that's something that centers have been building. So some centers currently only have text and chat capacity for a portion of the day.
For text and chat, my center's 20 We get text and chat from the whole state. They're not routed based on your location. So, it's a statewide queue. And anyone that we don't get to goes to one of the national back up centers. So then how do you route them to their local resources?
There is a statewide resource directory that's been created to help do that. And there is a timeline nationally through the FCC that will make text and chat routing similar to the call routing. It's just, I think, about two years out.
Speaker 1
little bit? You started talking about the surcharge part. Was it you that started
Speaker 1
Can you expand a little bit more on that? What is it that you were asking for?
Speaker 18
So the surcharge was reduced this year. It was $08 the first two years. It was reduced to $05 And I was highlighting that that seems incongruent with our goal of responding to all Californians who reach out to 988, either via call, text, chat, at a time where the need is going up by more than 30% to reduce the surcharge seems incongruous.
Speaker 10
Can I add, as another 988 center, right? Earlier, you heard DHCS say that their budget request funds the nine eighty eight centers to their capacity. And it's kind of a I think a very misleading way of saying it because our current capacity is resulting in, like we said, an 80% answer rate on calls roughly and only about a 40% answer rate on chat and text. There's also many other requirements, like we're required to do follow-up services, for example. And the speed to answer alone is an extremely high bar us.
It's very similar to nine eleven. And those aren't just federal standards. That's kind of how it was said that these are SAMHSA standards. That's true, but they're also state standards. Our contracts here in the state of California require us to meet the demand at those service intervals.
So to say that they're funding us with the BCP to our capacity is really just saying like, we're giving you a little bit more, only 2,000,000 more actually compared to last year, despite 30% volume growth increases. It's like so far off from where we need to be.
Speaker 1
Okay. Thank you so much. Deputy Director, can I have you respond to a couple of these things, and three in particular? Could you respond a little bit to I'll give you some if you want. Mhmm.
Up to yeah. We can share that mic with her there. Oh, yeah. Here. I'll No.
You can stay there. Sure. Just yeah. She'll stay right Can you respond a little bit to the funding? I was trying to get to that in my original question of the funding capacity and then tie that into why was there an $08 down to $05 decrease?
Speaker 12
Yeah. Thank So when you know, when we put together the BCP, right, we look at historical funding levels and try to take into account increased demands on capacity. But we don't, you know, practically speaking through the budget process, have an opportunity to ask for anything or any number. So we are somewhat, you know, taking into account, again, what we've been able to fund historically and building from there rather than starting with where where I think our partners started, which is what do they think they really need and capacity to improve performance. So our process is a little different.
We again, we share this cost information, and our centers are great advocates and share information about how they can would like to improve as well. Ultimately, that is a Cal OES decision to, you know, in this case, lower the surcharge from $08 to $05 So
Speaker 1
What is then our consultation to advocate? Because Cal OES doesn't, they have no idea what's going on here. They're they have no idea. So it's our our responsibility to let them know our needs. What is that I mean, I know it's a consultation, but, like, precludes us for saying, hey, we need more.
You're the gatekeeper here. Why can't we get more?
Speaker 12
Yeah. I think that's exactly how we should proceed. And can't speak for Cal OES in terms of their decision making process once they've heard this from us.
Speaker 1
Okay. Is it safe to say, Deputy Director, you're going to be sharing this information with Cal OES? Like, we need a little bit more. I'm just I'm trying to figure out how they're understanding our needs given that they're nowhere near the HCS issues or mental health issues. Like, how are they really grasping the the importance?
Speaker 12
Yeah. We do all meet and communicate. And we certainly have shared the current proposal and can continue the conversation about whether the needs are greater than the current proposal.
Speaker 1
And my other question was on I asked the counties who pays for it when the patients go to the hospital. If they're on Medi Cal, we're paying the cost if they're going to acute hospitals, right?
Speaker 12
Yeah, that's correct. If they're a Medi Cal member, that emergency department encounter would be paid by Medi Cal.
Speaker 1
Is there a potential then if we are not investing in preventative and doing the 52% out of my district, 40 something out of the other county, that Medi Cal is going to grow even more under this if we're going to see more of them going to the hospitals. So we're going to have to pay more out of the state. Is there a potential for that?
Speaker 12
Yeah. And I think those are the that I alluded to earlier. We'll need to look at indicators, right, if we proceed to this the crisis system is performing and what the impacts really are.
Speaker 1
Okay. Thank you so much, Deputy Director. Any final thoughts from our panelists? Yeah.
Speaker 10
I mean, I actually have some empathy to DHCS, right? They can only allocate to the nine eighty eight centers what they are given to allocate. Yes. And, you know, they're strong partners with the nine eighty eight centers, but the starting gate is way too low. So 30% volume increase this year to nine eighty eight, you know, 17% the year before that, 20% the year before that.
The volume just continues to go up and up and up, and we have twenty years' worth of data. So I think that, like, you know, because September was used to be known as the National Suicide Prevention Lifeline. So the evidence is clearly there that demand is going to continue to go up. There's going to be a public messaging campaign, state campaign starting next year. The demand is only going to increase to us.
So both OES and all the state agencies really need to be taking into account the current shortages and the increased volume growth stressors that are going to be on the 988 centers. Because we're the front door. Mobile crisis comes after the 988 contact. And even the law, AB 98, says that the nine eighty eight centers have to be fully resourced first. And we want to, you know, push all the contacts that are appropriate to mobile crisis, but we need to be sufficiently funded to be able to handle all the incoming volume and all the contract demands presently on us.
Speaker 1
Thank you. Thank you, everyone. Thank you so much. We're going to hold this item open. Move to issue number 10.
When you're ready.
Speaker 13
I'm Marlise Press, Department of Health Care Services. And so we're going to be talking about the Behavioral Health Services Act revenue and stability trailer bill language. So first question, you wanted a brief overview of the trailer bill proposal. So this trailer bill would amend the maximum prudent reserve levels and impose minimum expenditure requirements on counties under the BHSA funding. These requirements came from the Welfare and Institution Code.
And when Proposition one passed, which established a revenue and stability work group. And the whole purpose of the work group was to assess the year over year fluctuations in tax revenues generated by BHSA and really recognizing that a reliable strategy for short- and long term fiscal stability was needed due to the volatility of the tax fund. So the workgroup was tasked to develop and recommend solutions to mitigate BHSA revenue volatility and improve fiscal stability and to propose appropriate prudent reserve levels to support the sustainability of county programs and services. So, this trailer bill language would codify the solutions that were recommended by the BHSA Revenue and Stability Workgroup, once again, to really stabilize the fund. I'll move on to your next question.
So your question was around how does the reduction in the prudent reserve level for counties help address volatile revenues when in larger state budget contexts, volatile revenues generally are addressed with larger reserves. So a reduction in the prudent reserve amounts really helps reduce BHSA revenue volatility by ensuring that more BHSA funds remain available to counties to actively spend on BHSA programs and services, rather than sitting in unused large reserves, which was one of the reasons this was brought forward in the legislation. Counties have historically built up significant prudent reserves, but they did not draw on them. For example, during COVID, we did put some flexibilities in place around the utilization of prudent reserves, but only less than five counties actually accessed their prudent reserves. And there's some reasons around that.
Part of that is the way the counties are allocated their funds. This trailer bill does not impact their reversion periods. So, counties have three years to utilize their funds that they're allocated, and small counties have five years. So, traditionally, counties do not expend that first year allocation. It takes them two years.
So they have that funding as well, in addition to the prudent reserves. So by lowering the prudent reserve maximum to 10% for large counties and 15% for small counties, it really moves more service dollars out to the local level. It also still ensures that counties can maintain a print reserve if they want. Having a print reserve is not mandatory. It is optional for counties.
Question number three is, why is the minimum expenditure level calculated on the previous three years rather than a longer trend analysis? Given the volatility of BHSA revenue, would a longer trend analysis be more appropriate to smooth out the year over year fluctuations? So through these work group sessions, DHCS analyzed many different options for calculating the minimum expenditure levels. I apologize. Options included using historical revenue data, historical expenditure data.
We looked at using a three versus a five year trailing averages, and inflationary growth. And so, there's a lot of in-depth analysis I could get into around why using the historical revenue data was chosen, but that's because it's available sooner than expenditure data. So, we really felt that would present a more accurate point in time snapshot of the funding that's actually available to the counties. Also, historical expenditure data has a greater lag time than historical revenue, and that is due to the reporting timelines. We also added in this inflationary growth factor for years two and three, which would provide counties a more accurate funding estimate for their planning for those future years, especially as they're putting that three year plan together.
And then using the trailing three year average as a baseline for revenue will provide counties with greater stability for program expenditures as compared to relying solely on that yearly allocation. So the reason the three year weighted average was selected over the five year weighted average was to really better reflect current economic conditions and ensure that funding more closely aligns with recent revenue trends. And once again, that three year weighted trailing average gets more BHSA funding into the BH system sooner, as compared to the five year trailing average, which lowers the minimum expenditure level and requires counties to spend less funds annually. Question four, how would counties be permitted to utilize excess BHSA revenue they receive above their minimum expenditure levels? So when the revenues would exceed the minimum spending requirements, those funds could be directed toward any local need that the county determines, obviously, within those buckets, those three component buckets of housing interventions, FSPs, and the BHSS buckets.
So they could really be supporting if they have a chronically homeless need or wherever they need those funds to be applied. They could also utilize these funds if they haven't reached their maximum prudent reserve cap. They could put funds towards prudent reserve. And really, this is, once again, encouraging the use for the local needs of the funds. And it's intentionally designed to encourage to expand services and strengthen that system capacity.
So when there's years that the BHSA revenue exceeds the minimum spending levels, counties would be required to update their integrated plan or if they're in a cycle of an annual update. And they'd be required to update their budget to reflect the changes in revenue and how they plan to expend those funds. The next question: What would be the process for counties to access their new lower prudent reserves if BHSA revenue were lower than the minimum expenditure levels? How would counties address such a shortfall under the framework of these proposed changes? So, to determine whether the counties can access their prudent reserves, we would continue to monitor the fund source, the BHSF revenue throughout the fiscal year.
And then we would notify counties if there's a determination that the revenue is expected to be lower than anticipated. If we do see that that is required, we would provide guidance on the process and the expenditure timelines. And, of course, once again, prior to them utilizing the funds from the prudent reserves, they would have to do that integrated plan or annual update. Or there's also process known as an intermittent update, which can be done at any time in the three year cycle. So they would submit that to us through the electronic system that we have in place.
And once again, these transfers out of the prudent reserve can be used on any of those three components I mentioned. The only restrictions are around, like, with housing interventions, it wouldn't be able to utilize for capital development projects, or it wouldn't be able to be utilized for the capital CFTN, which is capital facilities and technology, or the WET programs. But really, just they could be using it for service funds in any of the other categories. And then, of course, they'd be reporting how they utilize these funds to the department. And that's the end of the questions.
Speaker 11
Will. Will Owens, Legislative Analyst Office. So on this trailer bill, on this item, our office has two issues to raise for legislative concern, the first being the reduction of the prudent reserve and the second being around the language for the methodology of setting those minimum expenditures. First, just want to give a brief background on kind of how this kind of came about. So during the process by which the legislature was, evaluating the government's proposal proposal to change the MHSA, our office released an analysis kind of highlighting the revenue volatility of the, millionaires tax, which is the the source of funding, for MHSA and now BHSA.
So our analysis found that the tax itself is about three times more volatile than the state's underlying general fund revenues, highlighting the significant variance that revenues come in for this process every year. Additionally, our office found that prior to the changes under proposition one, the reserve levels that were set under the MHSA appeared to be insufficient at those levels, which was about 25% or so of the county's total MHSA revenue was insufficient to cover even what would be expected fluctuations within revenue, let alone a serious downturn in revenue that could be expected from an economic downturn. So with that context in mind, the proposals set forth within the work group and then reflected in the trailer bill do take steps to try to account for some of that revenue volatility, particularly with the minimum expenditure level. However, we would just highlight first that the legislature, and this is somewhat highlighted in your agenda, could request additional information from the administration really detailing how the minimum expenditure level can account for some of this revenue volatility, particularly in the case of an economic downturn. So while the minimum expenditure level sets out a little more clear path for account expenditures on these programs, it doesn't necessarily account for large dips in revenue, for example.
So that would be one area to to look into, particularly, like I said, given that the trailer bill proposes further lowering the prudent reserve levels. The second, so the trailer bill itself does not actually specify the methodology by which the department would use to determine minimum expenditure levels. It's our understanding that they'll use the methodology that they described, the three year trailing average. But the language in the trailer as it currently sits would allow them to change it in the future. While this may be helpful for flexibility, it kinda limits over legislative oversight.
So the legislature may consider requiring, something like a thirty day notice and review period, prior to any changes, to this methodology just to ensure, proper legislative oversight over kind of this change in funding methodology. With that, available for questions.
Speaker 13
Yeah, so the statute required so the work group was hosted by DHCS and the agency, our agency partners. And the OAC was well, sorry, they just changed the name the Commission on Behavioral Health, Department of Finance, also CBHDA and CSAC. Those were the required and that was actually written in the legislation. And then we did, of course, have the meetings were open to the public. And we had, just in our July meeting, July '4, we had about 159 participants attended.
And so we had all our meetings, like I said, open to the public. But those were the required members that had to be a part of the work group.
Speaker 13
Oh, so sorry, Will. And they actually participated well and gave some great insights. I do recall that. Sorry about that.
Speaker 1
What do we believe is the disconnect? I mean, the county's proposed trailer bill language is very different to what the department is proposing here.
Speaker 13
So there were first of all, I just want to accent what the LAO said about the volatility of this trust fund, and that this is not we do not this is a very complicated issue to resolve. And there was a lot of differing I mean, did a tremendous amount of analysis. We hired some economists to assist us with this, as well. And I don't want to say that we think that we have it 100%. And we even talked about that in the work group, that we because we also researched having a state reserve.
And that was a really a proposal that we did a lot of research on. Instead of lowering the pre reserves and having that like the funding at the county level, should it be at the state level? And we did a lot of analysis on that as well. And so, what we really talked about in the work group is we felt like this not, was the best recommendation that we could all go forward with and try. And to the LAO's point, we didn't put the exact formula.
I mean, we have it in the report, what we would look to use with the three year trailing average and the percentages and why. We didn't want to codify that in trailer bill in case we needed to make an adjustment to it. So that was our thought process for that piece of it as well. So I think it's just differing priorities, quite honestly. I mean, the administration's priority, and you see it right in the statute itself, was around smoothing out the volatility, but also ensuring that the funding is being spent for local services.
And even in some of the analysis around the funding, I think you have to look at the prudent reserve, but you'll also have to look at what we kind of consider a savings account at the county, since they have three or five years to expend the funds and how much funding they have available at that time. So, if there's an economic downturn, there is still funding that they have in their what we call a savings account that could also be utilized. Or in the case of COVID, we acted really quickly and put a lot of flexibilities in place that helped the counties during that very obviously unexpected turn of events.
Speaker 1
LAU, back when Prop one was being discussed, suggested a 42% level for the prudent reserves. We'd landed on 20%, and now we're bringing it down to 10% or the proposal is to bring it up to 10%. A little bit more, if you can expand on the last comment you just gave of what happens in those economic downturns. Do you think 10% is enough for counties to turn to to cover their services in a time where that year they didn't get enough funding?
Speaker 13
Yeah, we do. And that's why we proposed that. And I do want to also just say that when this Proposition one language was in development, this was a really sticky widget. That's why we put it aside, brought this work group together, because we recognized that we needed some time and some thought to be put into this. But with the 10% and looking at once again, we looked at we have twenty years of data to look at from MHSA, and there were times that I think it was in oh, boy, I can't forget which fiscal year it was either 'twenty four or 'twenty five, but there was a big dip in the funding, and counties were still able to provide the services, and, you know, once again, didn't even need to use the prudent reserves.
And then, once again, in COVID as well. So, in all of our trend analysis, we feel that it could be covered. But once again, with this, you know, if we determine and we watch this as this moves forward, what's great about it is we can bring the work group together again. And if we need to make some shifts or try different options, that's still available. Unlike when we were looking at locking this in the legislation.
We didn't want to do that because we were concerned that we wouldn't be able to make this shift. So we're hopeful that this is what is needed. And once again, like I said, through all our different various analysis, this was the reserve levels that we felt could still assist a county. They could use their savings account and the prudent reserve in order to meet the needs locally.
Speaker 1
And when is the I don't think I see proposed implementation of the change.
Speaker 13
Great question. So the first, if this trailer bill is enacted as is, the prudent reserve levels, those would come into effect, the lowering of those, in July. And so counties would need to update through their annual
Speaker 13
Yes, 2026. I'm so sorry. Yes, so 2026. So this fall, they would be updating their annual updates is where they would make the change, and then it would be 'twenty seven. But then the rest of the changes wouldn't go into place until the next three year planning cycle.
So, three year planning cycles this integrated plan starts in 'twenty six, ends in 'twenty nine. So, it would be that next cycle where that minimum expenditure level would all go into place. Sorry.
Speaker 13
Yes. So, yes. So the next planning year cycle. So let's see here. Sorry.
Quick little math. 2930 is when our next No, it's '20 Yeah. Is for, Yeah. For the next integrated plan cycle. When does that happen?
Yeah, the first plan covers '26. So, it's a three year
Speaker 1
I apologize. Me. Okay. Okay. And then can you what is your response?
The county is saying that three years is still not enough time to capture. There's still a lot of volatility in capturing a trend within three years. They're asking for five years because that smooths out the trend. Can you expand a little bit more on what you think the difference in those two Sure. Why we landed on three?
Speaker 13
Yeah. So the main difference is it really just then puts less funding out into for services. The five years does. The three years just provides more funding locally for services. That's really the big difference, just because of the trend and how you're looking at it over a longer period.
So that's the main difference in our analysis.
Speaker 11
Just to make it clear, this is somewhat relevant to the prudent reserve level, too, but because the tax generally grows over time, when you expand it to five years, you're taking in more, like, lower amounts. And so the then, basically, it's that the three year average is the those past three years are generally higher on average than the past five years on average because those year four and five are generally lower.
Speaker 1
So that minimum expenditure would be lower if you're looking at a five year versus a three year. So that's your point of less less money for services if you're looking at a five year. Correct. Okay. Can you can you talk about the conversations occurring right now?
Is this because this proposal is out there, have all conversations stopped until negotiations happen with the three party, or are that still occurring right now?
Speaker 13
No, we're still having we've had conversations with our partners at CBHDA, and our agency and DOF partners were there as well when they were expressing their concerns. They expressed the same concerns throughout the work group process. And, yeah, so we're having those conversations.
Speaker 1
Okay. Thank you so much for that. No further questions. I'll hold the item open, move on to our last item here.
Speaker 12
All right. And this one will be short and sweet compared to the first couple. So I will provide an overview of our trailer bill language for aligning evidence based standards for substance use disorder treatment. And we are proposing this to align our state standards for SUD treatment facilities that are licensed or certified by the department with current evidence based standards of care. So existing law already requires DHCS to adopt American Society of Addiction Medicine, referred to as ASAM criteria, or an equivalent evidence based standard as the minimum standard of care for all of our licensed SUD facilities.
ASAM standards are periodically updated to reflect the current evidence base and consensus in the SUD treatment field. So at the 2023, ASAM replaced their third edition standards with the new fourth edition. And in the TBL, we proposed to update our facility licensure and certification guidance to align with those fourth edition standards. And the primary thing that we're doing is proposing to eliminate a licensure category that is no longer recognized by ASAM or supported by the clinical evidence. So currently, we are able to license residential treatment facilities to provide detoxification services only.
In the fourth edition standards, ASAM does not recognize detoxification as a standalone residential level of care. And in fact, ASAM does not, and has not for a while, recognized detoxification as clinically appropriate terminology at all. So the field has moved on, and detoxification services are now referred to as withdrawal management. And withdrawal management is really meant to be integrated within the broader continuum of residential treatment, not delivered as a standalone intervention, so that when someone is receiving that withdrawal management care, it not only addresses the physiological and psychological features of acute withdrawal, but also addresses the underlying substance use and begins to move people along that road to support and recovery services. So we are proposing to eliminate the detoxification only residential licensure category as of 06/30/2027.
At that point, all of the current detox only licenses will expire, and the facilities that do hold this license type must transition to provide integrated recovery and treatment services or recovery and treatment services that also include withdrawal management. We do have six facilities in the state right now, and that is six among more than 1,000 SCD facilities licensed by DHCS that are licensed for detox only. And one of the reasons we put this TBL forward now is to build in that one year transition period before the licensure change takes effect so that we can work with those six programs to figure out how they can update their clinical standards and the services they offer, and basically get one of the new existing licensure types to also provide treatment. The other thing that you will see in the trailer bill language is we are taking the opportunity to propose modernizing some of the other language in state law that refers to detoxification and replacing that term with withdrawal management in statutes that govern our DHCS Alcohol and Drug Program certification and our Narcotic Treatment Program licensure. So I will close here and just note that this TBL is needed to avoid cost inefficiency because we don't want to expend state funds licensing facilities to provide services in a manner that is not clinically supported.
And also, our health care payers, both commercial and our Drug Medi Cal and Drug Medi Cal organized delivery system, use ASAM standards and so would also no longer be paying for this detoxification only level of care. So it's, you know, efficient and appropriate, to retire this licensure type. Thank you.
Speaker 12
be difficult for those six to transition over? That probably varies depending on, you know, the current state of their service delivery. Some are larger organizations that also already, you know, may offer other services in other locations. So we do, think that adding sort of the treatment components and some of the changes they'll need to make will, should be feasible. But we'll we'll have more dialogue with them, certainly.
Speaker 1
Yeah. Thank you so much. We're gonna hold the item open. DHCS, thank you so much for coming in today. Issue 12 are proposals for investment.
None of them are for presentation, but take a look if you are interested in reading what they are. We're now going to move into a public comment portion of the hearing.
Speaker 12
Afternoon Chairman Gervar. Michele Cabrera with the County Behavioral Health Association of California. I first want to thank the chair and staff for a comprehensive hearing today. CBHDA urges the legislature to reject the proposed elimination of statewide funding for mobile crisis as discussed today. We also urge the legislature to consider, funding pressures on counties due to HR one, as well as to reject the state's proposed trailer bill language on BHSA.
And I'll just say really quickly that we've heard from multiple counties that they will need to end mobile crisis altogether, or scale back on hours and availability. But in all cases, cuts will be made. Thank you so much.
Speaker 19
Good afternoon, Chair Menjivar. My name is Peter Murphy. I'm the outreach manager for the Mental Health Association of San Francisco. And I've really enjoyed the conversation here today. We administer the California Peer Run Warm Line.
We're part of that continuum of care that was discussed. I'm a peer myself. I have an experience a lot like Matthew described today. The first care I got was in an ER. And you know, a lot of folks, the first care they get a lot of the time is in a correctional facility.
I've taken over 5,000 calls on the Warmline and we'd love to be able to meet with you in your office to discuss in more detail. We've been funded by the state. We're way upstream. We have the same concerns that were voiced here today that nine eighty eight addresses. We keep people out of crisis.
We start those conversations. We allow people to we to learn about mental health, to explore it with us. When I was coming up, there were no no conversations about it. It was it was taboo. And we save lives and we also save the community money.
And we'd love to meet with you to discuss it in more detail. So thanks very much.
Speaker 20
afternoon, Chairman Gervar. I'm Mark Salazar, the CEO of the Men Health Association of San Francisco. I'm here to urge you to support the $6,500,000 to restore the Calhoun Warm Line, and the Spanish Warm Line to twenty four seven operations. At its peak, our Warm Line was taking or receiving 40,000 attempts to contact us. We're we we were able to, answer about 25,000 of them.
With the budget cuts last year, we've only been able to answer about 3,000 to 5,000 calls per month, with 37% of those callers being Spanish speaking. So our goal is to restore the warm line at twenty four seven with the Spanish bilingual warm line with it together. So, thank you for your
Speaker 21
Good afternoon. My name is Diviya Shiv with the California Alliance of Child and Family Services. We represent over 200 organizations, including nonprofit community based organizations that serve children, youth, and families throughout the state, including organizations like Seneca, Sycamores, and DD Hirsch that were on the panel earlier today. California Alliance is strongly opposed to the proposed elimination of the statewide Medi Cal community based mobile crisis intervention services benefit included in the governor's January budget. Mobile crisis services are exactly the kind of investments we should be scaling, not cutting.
We stand in strong support of Subcommittee Number Three's proposals for investments to protect the statewide Medi Cal mobile crisis service, as well as the proposals for investments to increase nine eighty eight funding and to return the California peer run warm line to 20 fourseven operation. All of these are critical to save vulnerable lives in California. We also wanna thank the committee for including the list of programs that San Diego and Monterrey Counties plan to close due to the restructuring with BHSA. Closing these programs will deeply hurt the most vulnerable and create long lasting negative impacts. We support the idea of a service gap analysis, as you, senator Menjivar, asked.
Thank you so much.
Speaker 22
Afternoon. Mehron with CALVOICES. So regarding issue eight, the restructuring of the behavioral health funding is significantly affecting peer led organization. CALVOICES is poised to lose €2,200,000 in contract with Sacramento County in July 2026. We urge the legislature to direct the Department of Public Health to allocate the HSA population based prevention program funding to prioritize peer led organizations whose contracts are being eliminated, as these cuts are significantly impacting services for medical enrollees with severe behavioral health condition.
Regarding Issue nine, we are opposing the proposed trailer bill language to make the statewide mobile crisis a county funded program. Regarding Issue 12, a proposal for investment in support of the Fund to support the California peer run warm line operation. And finally, we urge you to integrate the over 9,000 certified medical peer support specialists to do HR1 outreach, as they are important, trusted of the community. Thank you.
Speaker 4
Good afternoon. My name is Sarah Weber with the Drug Policy Alliance. The Drug Policy Alliance also urges the legislature to maintain state funding to preserve the statewide Medi Cal mobile crisis benefit. Thank you.
Speaker 23
Lisa Hi. Lisa Christian with Mental Health Association of San Francisco. We run the Warm Line and do all the support for CalHope. That is an important part of our work. And riding on the story today, this continuum of care needs to be preventative, which is what the Warm Line CalHOPE does.
Mobile medical, 988, they all need to intersect so that we can support. Last year alone, we had over eight thousand people call about suicide. Of those eight thousand calls, only one percent were moved on to 988. And so it's an important preventative side of the story. So, in that support, we need to make sure that that whole continuum of care stands up to lift up our residents.
Thanks. Thank you.
Speaker 24
Thank you, Madam Chair. Brendan McCarthy with CSAC. We appreciate your comments on the challenges that counties are facing with H. R. One and other policy changes coming down from the federal government.
To that end, we oppose the proposal to make mobile crisis a county optional benefit, given that so many counties are not likely to be able to continue to operate that program that has been built up over the last several years. With respect to the BHSA revenue trailer bill, we are very concerned that the trailer bill actually makes it harder for counties to manage the volatility by shrinking the reserves and making it harder to access those reserves. So, we would align ourselves with the comments by CBHD and their letter about ways to improve that trailer
Speaker 12
Good afternoon, Chair. Caroline Grinder, on behalf of the League of California Cities. Cal Cities urges the legislature to reject the proposed elimination of the mobile crisis benefit. Cities recognize the important role that mobile crisis plays in responding to homelessness, reducing law enforcement involvement, and connecting people to resources and care in our cities. So for those reasons, we urge the continuation of that benefit.
We know the risks of shifting that to an optional county benefit. Thank you so much.
Speaker 25
Good afternoon, Madam Chair. Mike Sherif with Fans Law Government Affairs on behalf of the Steinberg Institute. The Steinberg Institute strongly opposes the proposal to make the Medi Cal mobile crisis benefit optional. California has invested in building out the nine eighty eight crisis system, but the nine eighty eight is only as effective as the response behind it. Mobile crisis teams are that response.
They meet people where they are, de escalate, connect them to care and keep them out of jails, emergency rooms, and hospitals. Making this benefit optional creates a patchwork system where access to care depends on your zip code, and it undermines the very crisis continuum the state has worked to build. We strongly urge you to reject this proposal. Thank you.
Speaker 26
Afternoon. Josh Gogger on behalf of Multiple Clients. On behalf of the urban counties of California, we are opposed to the administration's Behavioral Health Services Act revenue and stability trailer bill proposal and hope to find an agreement on further amendments. Counties share the goal of stabilizing BHSA funding, but the proposal would reduce prudent reserves and limit local flexibility at a time when counties face growing fiscal uncertainty. This proposal does not address concerns raised by counties when the BHSA was negotiated, which was to create a mechanism to plan for peaks and valleys in a very volatile revenue source.
We urge amendments that will help ensure counties can responsibly manage BHSA resources and continue delivering services in a volatile fiscal environment. On behalf of Ventura and Riverside Counties, the counties are concerned about the mobile crisis proposal. Ventura estimates new county costs of 2,000,000 to $5,000,000 and Riverside is concerned it will impact their efforts that have led to diverting 70% of crises from law enforcement and hospitals. Thank you.
Speaker 27
Madam Chair, I'm Darryl Hamilton with Kingsview. To comment on agenda item four thousand two and sixty, our agency provides nine eighty eight services for Sanislaw, Merced, Mariposa, Madera, Fresno, Kings, and Tulare Counties. Kingsview is a member of the nine eighty eight California, the consortium of California's eleven nine eighty eight crisis centers, which have responded to 2,800,000 help seekers since 2022. Today, we ask you to consider our budget request to ensure all Californians in crisis have access to to timely care that they need. As you already heard, California's nine eight eight centers can only respond to 40% of incoming text and chats due to funding constraints.
Our text and chat team is currently available, fourteen hours a day. We are eager to expand our capacity and provide much needed support and connection to care for our community. Thank you for your commitment to suicide prevention and crisis care.
Speaker 28
Madam Chair, Danny Offer with the National Alliance on Mental Illness, also known as NAMI California. Thanks for all the time you've given to this issue. Obviously, we're opposed to the mobile crisis proposal. You know, a lot of our members are family members of people with a mental illness. So, we surveyed our members to ask them, you know, have you had interactions with mobile crisis?
What's that been like for you? And just briefly, in the twenty seconds I have here, I just wanted to share a quick snapshot that one family shared with us that, you know, it was a saving grace for that family. The team didn't just come out for one time, it was multiple incidents that they came out for. They built rapport between the family and law enforcement. They helped get their son to the right level of care, and now he's getting the treatment he needs, rather than just temporary stabilization, and helped him avoid involvement with the justice system, which is where the family was sure their son was going to go to next.
This is what our crisis continuum is supposed to do. Shows up in the communities, stabilizes the situation, and helps determine the right intervention. So, thanks for your
Speaker 29
Afternoon. Darby Kernan on behalf of two clients. On issue nine for the EMS Administrators Association of California, we oppose the governor's proposal to eliminate the state mobile crisis funding and associate our comments with CBHDA and CSAC and ask you to reject that proposal. On issue eight, the First Five Association, which represents all 58 counties' First Fives, is concerned about the transition from MHSA to BHSA, which threatens to eliminate millions of dollars in prevention and early intervention funding that currently supports infant and early childhood mental health services across California. In the agenda, it lists out several First Fives that are providing these services that are losing that funding.
Thank you very much. Thank you.
Speaker 30
Good afternoon, Madam Chairwoman and fellow social worker. I'm Doctor. Lisa Pyramberlin, the President and CEO of Parents Anonymous, Inc, who runs the only California parent and youth helpline, twenty four hours a day, seven days a week. We have a budget request to continue that the outreach to parents who feel blamed and shamed for every issue, whether it's they are trans or they are facing immigration issues or fires in the LA area, people are calling us off the hook. We cannot respond.
We've already estimated this year alone 45,000. That's 25,000 Californians and at least 10,000 Latino families who are reaching out. We have young people who are being bullied, who are calling and texting. We have parents who are afraid they're gonna be picked up by ICE. And will they be home in the afternoon or even able to drive their children to school?
These are real issues that they face. And we, at Parents Anonymous, are a trusted, entity that we started the California Periodontal Point with the support of the governor during COVID in 2020. We're coming to the sixth anniversary, actually. And we need this continued $5,000,000 a year for the next three years to continue to serve California and save lives. Thank you.
Speaker 16
Angela Good afternoon. Angela Herrera, Parents Anonymous. I'm a parent advocate. Watching my mom go through stage four cancer has been one of the hardest experiences in my life. There's a constant mix of fear, uncertainty, and the pressure of trying to stay strong for both her and my family and myself.
Some days feel overwhelming, balancing parenting responsibilities and coping with emotional weight of my mother's illness. Reaching out to the California parent and youth helpline has made a real difference for me. Having someone to talk to who listens without judgment helps me feel less alone. They give me my space in process to process what I'm going through and offer support during moments when I don't know how to handle everything. The California Parent and Youth Helpline gives parents, children, and youth space to turn space to turn to.
Families are breaking under heavy burdens and need help with this helpline more than ever. I urge you to please fund the helpline. It saves lives and strengthens our communities. Please don't families don't have to suffer on their own. Thank you.
Speaker 7
Afternoon, Chair. George Cruz, on behalf of the California Behavioral Health Association. CBHA represents providers across California, including the one third of nine eighty eight call centers. California's nine eighty eight system is a core part of the behavioral health continuum, and demand continues to rise. California now averages about 52,000 contacts per month.
That's a 57% increase since its launch. The crisis centers report a statewide need far above the current funding levels, and at the same time, proposals shift mobile crisis towards county funding. This creates an uneven access and places pressures on providers and emergency systems. CBHA supports the budget proposal sorry, to increase nine and eight funding to meet the growing demand, and we urge the legislature to support it as well. Thank you so much.
Speaker 12
Good afternoon, chair. My name is Austin Georgio Williams, and I am with the California LGBTQ Health and Human Services Network. We urge legislature to maintain the statewide mobile crisis benefit and reject its elimination. Mobile crisis services provide essential affirming care for LGBTQ individuals who frequently face discrimination and trauma in traditional emergency settings. Defunding this benefit would remove a primary pathway for safe behavioral health support for a community that already experiences so many significant health disparities.
We ask that you recognize the necessity of this service and ensure it remains fully funded. Thank you. Thank you.
Speaker 31
Good afternoon, Madam Chair. My name is Antonia Rios. I'm a Parents Anonymous parent leader. I stand here before you today because of the California Parent and Youth Helpline that saved my 11 year old and my daughter's life. My 11 year old was looking for the fastest way to die due to medication change, and my daughter was struggling with youth partner violence.
No parent should face something like this, and, but we did, and so did my children. I'm sorry. It is really hard to come up here and tell you that we could have lost my child not only to suicidal, but my other child due to kidnapping and held hostage. And if it weren't for this California parent and youth helpline, they wouldn't have had the courage to be here today thriving and advocating for the California Parent and Youth Helpline. And that's not the only thing that occurred in our life.
My child shared the Helpline card, which saved two others of his peers who had planned to take their own life. And because of this helpline, they are here today, and they're all about to graduate. So I beg I beg you. I plead literally with tears and pain in my heart to continue this funding for the California Parent and Youth Helpline. It is lifesaving.
It's like no other. Thank you.
Speaker 32
Carol Sewell from California Elder Justice Coalition, and also speaking on behalf of the California Commission on Aging. Older adults clearly are not well represented here, but they are the largest proportion of the population, and they have the highest successful rate of suicide of any age group. Older adults are clearly identified in the BHSA as an underserved population, yet they are rarely mentioned in the county plans. The integrated plans do not call out any services, specifically or very few are calling out specific services. And many of the evidence based programs that serve older adults have already proposed, are gone for elimination, or are gone.
We know that many older adults don't reach out on their own. Prevention and early intervention is as important for older adults as it is for the younger population. And it's not clear that that's going to be available at all. So we urge you to work with the department to begin to gather data on older adult services, and to call out this important population. We're in the mid year of the master plan for aging, and we're ignored.
Speaker 33
Good afternoon, Madam Chair. My name is Christiana Bosch Gazau. I am the director for Buckalew Programs nine eighty eight Call Center. Our center provides service to Marin, Sonoma, Lake, and Mendocino Counties, and I'm here to comment on agenda item number nine. Over the past year our center has seen a 70% increase in call volume compared to this time last year.
Yet our budget has remained flat since last fiscal year. At the same time expectations placed in our center have grown. Our staff is doing an incredible job to meet this rising need, but without corresponding increase in funding, it becomes increasingly difficult to maintain the level of care our community deserves. Thank you. Thank you.
Speaker 34
Madam Chair and member, here to comment on issue number nine. I'm Christi Gonzales with WellSpace Health. We provide nine eighty eight suicide prevention services to 30 counties in California, and we're a member of the nine eighty eight California Coalition of Crisis Centers. We ask you to review the nine eighty eight California letter dated April 17 regarding the trailer bill language on AB nine eighty eight. Specifically, we are requesting adding nine eighty eight California as a designated partner for consultation as it relates to the operational and financial forecasting, similar to the way that CBHDA has inclusion when it comes to BHSA funding and deliberations.
As you heard today, both DHCS and OES are wildly inaccurate in their financial forecasting of need. And only by including the voice of the nine eighty eight providers can this body have an accurate understanding of what it will take to keep Californians safe. Thank you for your continued commitment to suicide prevention.
Speaker 35
Good afternoon. My name is Simon Vu with the California Behavioral Health Planning Council, and, we urge the legislature to reject the proposal to eliminate the statewide Medi Cal mobile crisis benefit. Mobile crisis team are an essential part of the California behavioral health crisis continuum. About forty four percent of adults who use mobile crisis services engage mental health treatment within thirty days, which is a clear indicator that this benefit works. And making this benefit optional would, force many counties to cut services, leaving children, youth, adults, and older adults without timely care timely access to care.
And so we cannot afford to dismantle a system that is already saving life and improving outcomes for many Californians. Thank you.
Speaker 1
Thank you so much. Seeing no other person wishing to give a public comment, the subcommittee is now adjourned. Thank you.
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