Budget Sub3 — 2026-04-30 (partial)

Hi, this is you again. I'm Stephanie Clendenin, Director, Department of State Hospitals, and I'm joined by Chris Edens, our Chief Deputy Director of Program Services. I'll start off by providing a brief overview of the department, its budget, and provide a high-level summary of our caseload updates for the patient-driven OE&E item and the incompetent to stand trial solutions item, and then I'll turn it over to Chief Deputy Director Edens to provide the updates on CONREP non-SVP and answer the question in the agenda regarding the LPS allocation methodology. The Department of State Hospitals manages the California State Hospital System. Our mission is to provide evaluation and treatment in a safe and responsible manner by leading innovation and excellence across a continuum of care and settings. We operate the five state hospitals located throughout California with inpatient beds that include acute, intermediate, and skilled nursing facility levels. We have a conditional release program by which we, which are a system of community-based services that are operated in partnership with county behavioral health departments and private providers that is designed to transition patients back into the community following a forensic commitment to DSH. And we also have partnerships with county behavioral health programs, private providers, and county sheriffs to provide community-based restoration, diversion opportunities, and jail-based treatment programs for individuals committed to the department as incompetent to stand trial. The individuals served by our system are mandated for mental health treatment by either a criminal or civil court judge or the board of parole hearings. And the majority of individuals we serve are forensic commitments. They have either committed or been accused of committing crimes linked to their mental illness and come to us directly through the criminal courts or after they have completed a sentence at the California Department of Corrections and Rehabilitation. This includes individuals that are committed to the department as incompetent to stand trial, not guilty by reason of insanity, offenders with mental health disorders, and sexually violent predators. We also serve incarcerated persons from CDCR who need inpatient mental health services. That's the Coleman patients. And lastly we serve individuals conserved by a civil court under the Lanterman short Act With respect to the department budget the proposed budget for fiscal year 26 totals billion including state operations and capital outlay which represents a decrease of $34.1 million, or 1%, from the 2025 Budget Act. The proposed budget includes four permanent positions and two one-year limited-term positions in budget year. The decrease in funding is primarily attributed to IST solution savings and the new positions are to address dental workload and implementation of SB 380, a transitional housing study. As it relates to our caseload estimates, the department is projecting a census of 8,317 by the end of fiscal year and 8,427 across its programs by the end of fiscal year 2627. The increase is primarily related to expected increases in community-based restoration and diversion placements for individuals deemed incompetent to stand trial. For the caseload update related to patient-driven operating expenses and equipment, the Budget Act of 2019 adopted a standardized methodology to provide funding for patient-related OE&E items based on updated census estimates for each fiscal year and an estimated per patient cost derived from past year or actual expenditures. Due to rising costs, DSH requests $19 million in fiscal year 25-26 and $19.6 million in 26-27 and ongoing for increases in costs of utilities, pharmaceuticals, foodstuffs, and outside hospitalization. We are seeing higher costs due to inflation, particularly in the areas of outside hospitalization and pharmaceuticals, and the higher cost in the budget years due to a higher projected caseload census. Moving on to incompetent to stand trial solutions as of the governor's budget, the department projects a one-time savings of $114 million in 23-24, $117.8 million in current year and $94.2 million in budget year. The 23-24 projected savings is related to counties who have not yet progressed with their IST infrastructure project. DSH is proposing to revert any obligated funding in this program. This funding was originally appropriated in fiscal year 23-24 with five-year encumbrance authority to provide grants to counties to develop additional housing to support incompetent-to-stand trial individuals receiving services through diversion or community-based restoration. The projected current year and budget year savings are primarily a result of updated phased inactivations of DSH diversion and community-based restoration programs and programs serving lower census levels than the maximum budget the program is projected to support. The agenda asks that we provide an update on the progress made in meeting court orders in the Stiavetti v. Clint Denon case and the impact of recent policy changes including SB 1323 and Prop 36. As it relates to Stia Vetti, to provide some background as a result of the department experiencing significant year-over-year growth and referrals of individuals deemed incompetent to stand trial that exceeded the department's ability to create sufficient additional capacity, the department experienced increasing wait lists and times for restoration of competency services. services. In 2015, the ACLU filed a lawsuit focused on the time that IST defendants were waiting in jail to be transferred to DSH's inpatient programs, and ultimately the court ordered the department to initiate substantive treatment services within 28 days for IST defendants. The court set an initial deadline for the department to achieve the 28 days and also set interim benchmarks for the department to achieve towards meeting that 28-day deadline. The court then revised the initial deadline and benchmarks in the fall of 2023 due to the impacts of the pandemic on our system and ultimately court required the department to achieve 28 days by March 1st 2025 with interim benchmarks to achieve 60 days by March 1st, 2024, 45 days on March 1st, 2024, and 33 days in November of 2024. The 2022 Budget Act included a significant investment towards additional IST solutions. These solutions, along with other investments in prior budget acts, included short-term and long-term strategies centered around two primary goals. The first being to initiate treatment services for IST individuals within 28 days, as required by the court. And the second was increasing community-based treatment and diversion options with the goal of reducing criminalization for individuals with serious mental illness. As a result of the rapid implementation of IST solutions, easing of the pandemic impacts on our facilities, and other efforts, the department has seen substantial decrease in both the IST wait lists and wait times and met all of the court's ordered benchmarks and continues to provide timely access to services for individuals found incompetent to stand trial within 28 days. And to provide a measure of that progress, during the pandemic in January of 2022, we had reached an all-time high of 1,953 IST individuals on the pending placement list, with the individuals averaging over 140 days to treatment. At the beginning of April this year, we had only 250 individuals on that pending placement list. 250 individuals represent significantly less than one month's worth of referrals. As of this fiscal year, we're receiving an average of 405 referrals per month. The average time to initiate treatment for IST individuals in March was around five days. With respect to the impacts of SB 1323 and Prop 36, Prop 36 provides for specified drug and retail crimes that previously were charged as misdemeanors to be charged as treatment-mandated felonies or receive increased sentences. This increases the range of crimes for which someone may be found incompetent to stand trial on felony charges and referred to DSH programs for treatment. Therefore, it may increase referrals to DSH. However, the number of individuals referred to DSH for treatment may be offset by the application of SB 1323. Don't really need to tell you, Chair, about this bill, but I will provide a little highlight on it. SB 1323 became effective January 1, 2025. It included amendments to modernize the IST process by providing judges the authority to determine if restoration of competency is in the interest of justice, and if not, to provide longer-term, more comprehensive treatment options with an emphasis on mental health diversion. Under SB 1323, when a court finds restoration is not in the interest of justice, the court must conduct an eligibility hearing within 30 days to determine if the individual is eligible for placement into a diversion program. And if not eligible to be granted a diversion, the court may consider a referral to the public guardian for conservatorship investigation, assisted outpatient treatment, care court, or may reinstate competency proceedings. This provides an earlier pathway intended to divert eligible individuals into community-based treatment when appropriate, rather than referring to inpatient restoration of competency treatment at DSH. So we continue to monitor our IST referral rates and the potential impact of both Proposition 36 and SB 1323 but overall to date for this fiscal year the department is experiencing a small reduction in referrals compared to last fiscal year During the first eight months of fiscal year 26 we received an average of 405 IST referrals per month compared to an average referral last year of 451 per month. So I'll now turn it over to Chief Deputy Director Edens to cover the remaining items.

Department of Finance, do we have anything to add? Will?

Director, can we go back to on number three when you were explaining just an update on the Prop 36 and SB 1323? Did you mention one of the last things you gave numbers on the increase from 400 to about 441 per month in court referrals? Is that because of Prop 36? Is that why that's the increase?

But is it just kind of like tearing out to a status quo because of Prop 36 and 1323? So is 1323 the intent was to minimize but not because of Prop 36? Is it fighting against that intent?

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

You know, and I saw, thank you for that. You know, outside globalization is the one that's dramatically increasing against everything else. Is there any preventative measures we can implement or turn to? Or is this just a matter outside of looking for more competition and so forth?

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?

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?

Okay. And then talking about the IST solutions, you broke down all the savings since fiscal year 23-24. Can you share maybe Departate Finance's 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?

Okay, so nothing is being added. Right. Nothing is requested.

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

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

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

Yes, correct. Based on what we know today. Yes, okay. And outside of the saving solutions proposed now, is there anything we adjusting for better budget allocation under these programs So we don continue over budgeting It seems like we continue over budgeting for this?

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?

Okay. So it's not a full gap.

Okay. And then Chief Deputy Director, on the delay of activation on the new Central California facility, it was supposed to come online January 2027. The delay pushed it to what time?

That is the current? Yes.

Yes, we were assuming that it was going to really be coming online much sooner than that. Okay.

And because the savings came from that, is there any need for any outside additional funding to get that online in January 27, or is that funding already ready to go for that activation?

Okay, great. Thank you. Okay, no further questions on the overview. We're going to move on to issue number two. I'm going to hold that item open.

Department of Finance, anything to add? Well, anything to add? Oh, yeah. 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 costs being calculated in the structural deficit?

I'm wondering if the rest of the funding is being calculated under the structural deficit.

I don't know how long the requests are going to, I think, to lead up all the way to $95.1 million. We're going to have to calculate into our structure deficit for at least, what, four, five years? Is that correct?

So is it being added? Is it included in our structural deficit?

I 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 have to continue So I wondering why a Department of Finance proposes these type of BCPs in a different manner where other BCPs are X amount this year, X amount the next year, until the project is complete, and this is being proposed as a one-time, which I don't view it as a one-time, because you have to come back to continue the project.

If we come to a more deteriorated state next year fiscally and we have a phase, yeah, it would be... Worse than $18 or $20 billion.

delaying it a year or two, the legislature would have the flexibility to do that. Okay. Well, I don't anticipate that administration shouldn't ever come in and say let's delay what we've already invested in. 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 costs, and then that would increase to X, Y, and Z. Mr. Beckley? Beckley, yes. I'm so sorry. I forgot your title, so I apologize. I'm not using it. whatever you're allowed to do without sugarcoating, is Pantene going to fall apart if we don't start this now?

When I got briefed for state hospitals, the first thing I asked, I was like, Nora, tell me how many BCPs do 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?

Hi. Hello. Thank you. We actually are waiting for DGS to hire their architect of record,

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

Well, no, 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. But for the preliminary plan phase, that takes a while for the DGS sometimes to actually get the contractor on board and hired. The funding was sent to them on September, and the funding came to us in July. So it just the time period it takes to go through the contracting process sometimes and we waiting for that part to start I don 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.

Typically 12 months.

You won't? Well, it could some potential. 12 months, and the contract hasn't been allocated yet. Well, it's typical 12 months is a good rule of thumb, but we asked EGS about this,

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

Well, according to DGS, they're basically estimating it would take less than 12 months. 12 months, again, is just a rule of thumb for preliminary plans. But even if we ate into the next fiscal year a few months, we'd still be saving that 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.

Hello again.

Hi. Chief Deputy Director of Program Services, Chris Edens, and I'm joined by Stacey Camacho, Deputy Director of our Community Forensic Partnerships Division, which oversees our conditional release program. This is a budget change proposal about Senate Bill 380. The department is proposing $469,000 one time in the budget year to support two one-year limited term positions to implement Senate Bill 380. This bill requires the department to conduct a feasibility analysis on the establishment of transitional housing facilities for the CONREP SVP program and to submit a report to the legislature on its findings of the analysis by January 1, 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.

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

until the court deems that they 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 deputy director, but it usually is a few years in the program.

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

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.

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

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 of 2024 by the California State Auditor. There was an audit report that was released on the CONREP 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 biggest issue is that we did not see that transitional housing would ultimately solve the problem of placing individuals in their county of domicile. Because ultimately even if we do have a transitional facility at some point the court is going to then require and the individual is then ready to step down back into their community And so we will still be faced with the task of having to place individuals in their county of domicile

Essentially, yes.

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.

So on SB 1323, when they are diverted through SB 23 in the interest of justice, and they are ultimately diverted. The bill also included a change to 4361, which is our statute for DSH diversion, and it 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 DSH, both pathways, they will receive funding under the DSH diversion program. So the IST solutions, it's not like they can be used in other areas to support that same kind of population? It would be just for individuals found in competent to stand trial and felony charges.

Right. So an individual under SB 1323 is first found incompetent to stand trial, and then the court makes the decision whether it is in the interest of justice or not in the interest of justice. 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. DSH diversion program.

No.

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.

Thank you.

Good morning, Brenda Graylish, Executive Officer for the Commission for Behavioral Health. Thank you so much for the opportunity, Chairman Javar, 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 Commissional 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 pivoting to implementing innovation on the state level through our new Innovation Partnership Fund grant program which provides up to million 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 that the county and provider levels. So the commission's role at this moment is to really help California make this transition real and workable, to gather what is happening on the ground across our counties and our communities, to bring transparency to how funds, programs, and outcomes are aligning with the intent of the law, to surface what's working and where barriers are emerging, and to translate those lessons into practical improvements through data evaluation, technical assistance, innovation, and recommending strategies to improve implementation of the Behavioral Health Services Act over time. Any questions on our overview?

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

Sorry.

So there was a great background in the agenda on our Innovation Partnership Fund work. Under the Behavioral Health Services Act, innovation moves from the county level to a statewide strategy. 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 million allocation of the Innovation Partnership Fund. That RFA was released on March 20th. The fund offers two distinct grant categories, one for small grants exclusively for community-based organizations, non-profit entities, and tribal organizations. So we're looking to have at least eight grants under $500,000, and then one for large 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 million. 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 to be due on May 8th. 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 local BHSA implementation on July 1st. 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?

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 priority populations that are defined in statute, which are those who are at risk of homelessness, institutionalization, conservatorship, involvement with the justice system, and or involvement in the child welfare system. And so to be eligible for this grant program, proposed solutions must be innovative. We have the definition of innovation. It needs to address the needs of these BHSA priority populations. and that needs to apply to or support county implementation of programs or practices to best serve the HSA 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 new or 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, 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 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 that counties can still fund innovative pilots under the Behavioral Health Services Act through the Behavioral Health Services and Supports component. And that makes up about 35% of county funds. But unlike under MHSA innovation, the BHSA no longer requires the commission to approve those projects. And so innovation is now one new option within that bucket alongside other allowable uses for counties that also includes things like early intervention. So that counties can retain their flexibility to innovate locally, while the innovation partnership fund at the state level creates that statewide, dedicated statewide pipeline to test, evaluate, weight and scale approaches that counties can later adopt. At the same time, the Innovation Partnership Fund is smaller than the prior MHSI innovation structure, so our approach is to maximize impact through our projects and really looking to impact changing how innovation happens. So really by taking the burden off of counties 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,

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. So stop there.

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.

We haven't operationalized all that yet, so I think this is all in development. And so this is our first time working on this. I think there's nothing that precludes us. at first blush, I'm not aware of anything that concludes that.

for our next round as well Because this is million forever however long this continues right This it it it a this IPF is million and up to million for five years Oh, it's only for five years. Only for five years. Yeah.

Well, it's for it's $20 million per year and we get that allocation for the next five years.

then we'll have to start asking for more through budget requests.

Yeah, it's $100 million.

Okay.

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 separately apply for them. I don't know.

I'm just looking at my team. Yep, they said that.

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

crisis units, yes.

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.

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

So if they just want to train their employees, that covers it? Like if there's a new training, 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.

they're like actual service deliveries kind of innovative investments. I will say, too, part of the statute signified that the commission would work in collaboration with CDPH, HCHI, 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.

Oh, Williams with the Legislative Analyst's Office. I'd like to – so the commission would – 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 go –

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

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. Alcove 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 $14.6 million in one-time grants over a four-year period of time to support the establishment and expansion of Alcove models statewide under the commission. So in January 2020, the commission allocated $10 million for site grants and $4.6 million 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 4 and 5 grants, which went to some all-co centers. So while the commission had conducted the CYBHI Round 4 and 5 grant procurements, those grants are administered by the Department of Health Care Services. All that funding has been allocated and disseminated to their sites. The commission, however, 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-code projects, the commission's all-code 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 really, we're looking to have that extension so that we can continue the funds so that they can just finish spending down the remaining funds. Otherwise, they revert on June 30 of 2026, so just in a couple months, before they would be able to finish their implementation, stabilize operations, and really wanted them to finish collecting that data so that we can have the data for all of the sites for the final evaluation. So basically, being able to get this reappropriation will help protect our state investment, allow these programs to finish implementing as designed and making sure that Stanford can get all the, as the independent TA entity and their evaluator to get enough data

All right, ready for me to jump in?

Paula Wilhelm, I'm the Deputy Director for Behavioral Health at DHCS, And my colleagues with me today are Marlise Perez, who is our project executive for behavioral health transformation and also our division chief for community services. And then I also have Ivan 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 Organized Delivery System services for the 25-26 and 26-27 state fiscal years. So during this time period, the department has continued to focus on implementing the behavioral health components of California Advancing and Innovating in Medi-Cal, or CalAIM, while also launching new benefits and activities under the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment Initiative, which I will now refer to as BH Connect. As you may know, CalAIM benefits and policies for behavioral health included the launch of Medi-Cal peer support specialist services, mobile crisis services, contingency management services, also known as recovery incentives, and more recently traditional healthcare practices. CalAIM was also focused on updating our administrative policies in order to reduce complexity for our plans, our providers, and our Medi-Cal members, and improve behavioral health access and quality. So some of the policy updates we've made include updated criteria for access to specialty mental health services, our no wrong door policy for mental health, standardizing screening and transition tools to help people access mental health services, updates to our clinical documentation requirements, and behavioral health payment reform. So we continue to sort of update those policies in response to feedback. And early this year, we finalized and published refinements to guidance on the specialty mental health access criteria. So we now have a list of DH-approved youth trauma screening tools that can help practitioners determine when youth meet the criteria to access specialty mental health. We also made updates to our standardized screening and transition of care tools for mental health services. and those were to allow practitioners to intervene or override the screening tool direction based on their clinical judgment. And all of that in response to watching implementation play out and getting feedback about areas where different or further guidance was needed. So a new CalAIM priority that will be focused on in fiscal year 26 will be the implementation of updated standards for substance use treatment or SUD provided through our Drug Medi and Drug Medi Organized Delivery Systems You'll hear me say DMCODS for Drug Medi-Cal Organized Delivery System repeatedly here. Under existing law, Drug Medi-Cal and the DMCODS providers must use American Society of Addiction Medicine, or ASAM, criteria to determine the appropriate level of care and treatment services for Medi-Cal members. So ASAM has now released new clinical standards referred to as their fourth edition standards that must be adopted both in 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 2027 so that our systems can implement by July 1st of next year. I also 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 have seen real growth in this. And we're also excited about the data that shows the efficacy of this evidence-based intervention for stimulant use disorders. So we have seen that 95% of our Medi-Cal members who receive contingency management test negative for stimulant use over the course of their treatment, And that 95% exceeds the average of 85% that we generally see in the literature on this service. We'll also mention that those 21 counties that are providing contingency management cover approximately 80% of our Medi-Cal members right now. So we're really looking forward to continuing to build this capacity for this important service. Over the course of 2025, we also worked closely with tribes and tribal partners to implement Medi-Cal coverage of traditional health care practices. So this was an exciting first in the nation approval that we received alongside three other states in fall of 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 DMCODS counties if they have an IHCP that chooses to participate to cover those services. We released our initial implementation guidance on this benefit in March 2025. And at this point, we've approved 21 IHCPs, Indian health care providers around the state to serve Medi-Cal members with traditional health care practices. We also mention that we were initially authorized to cover traditional health care practices for two years and change so just through the end of December 2026 But we do plan to seek renewal of this opportunity for up to five years in our forthcoming CalAIM Section 1115 waiver renewal application So really hoping we get the opportunity to continue building and expanding on this. Shifting to talk about BH Connect, which continues to be another area of focus for us, You may know and remember that BH Connect is a group of policies designed to strengthen and increase access to a continuum of community-based behavioral health services for our Medi-Cal members who have the most significant behavioral health needs. So to date, we've implemented multiple components of the BH Connect initiative. In 2025, we were able to launch our $1.9 billion access reform and outcomes incentive program. So this program creates an opportunity to reward our county behavioral health plans for improved performance on quality measures. And we did make initial payments totaling $48.6 million to 42 counties based on their progress on these measures. And that's consistent with our planned schedule. So by the end of this year, they'll have an opportunity to earn quite a bit more for their performance during calendar year 2025. DHCS is also working really closely with the Department of Health Care Access and Information or HCI to launch the behavioral health workforce initiative. So this is a $1.9 billion program to expand our behavioral health workforce in Medi-Cal. In 2026, DHCS and AHCAI 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 1st. And so BH Connect offers counties the opportunity to draw down federal funding for these interventions and use Medicaid dollars to help build out those BHSA required programs. Counties that commit to implementing a full suite of new evidence-based practices also have an opportunity to receive federal financial participation for short-term stays in inpatient or residential facilities that qualify as institutions for mental disease or IMDs. As of April 2026, we have four counties that have been approved to participate in this mental health IMD program and will be focused on building out those evidence-based services and reinvesting the additional federal financial participation that they will receive. And those counties are Riverside Santa Clara Sacramento and San Diego So looking forward to supporting their efforts Finally as of January 1 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 And that will take effect July 1. Alongside these updates to Medi-Cal coverage, again, high 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.

Okay, we'll keep going. So the committee had asked if the administration tracked or analyzed local county behavioral health programs that may be defunded due to the reallocation of funding included in the BHSA and also asked about how the department plans to address any loss of reach or capacity represented by the closure of local programs. So first, I think DHCS really wants to acknowledge the incredible engagement and thoughtful feedback, recommendations, and concerns we've received from our counties, our providers, a whole array of behavioral health stakeholders, community members, and from the legislature as we are working to faithfully implement the Behavioral Health Services Act statute. This was a vision for transformational change that requires fundamental updates to the way counties organize and finance public behavioral health services and the way they prioritize populations, which Brenda alluded to earlier. So as we all manage that change, we recognize there will be difficult local decisions about how to prioritize spending and many implementation challenges to navigate and respond to. The BHSA did reimagine the required program components that were formally under the Mental Health Services Act to ensure the BHSA priority populations receive evidence and community-based services. So you're familiar with the three BHSA categories of housing interventions, full service partnership, and behavioral health services and supports. Counties are required to develop three-year plans that address these identified priorities. DHCS is committed to then monitoring county performance and progress toward our statewide behavioral health goals as implementation proceeds after July. We have primarily heard from stakeholders about reductions in local prevention organizations oriented contracts in response to the shift in responsibility for BHA 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 are just completed their draft plan submissions and are moving to final and that they spend their behavioral health funds according to those plans and then again we will look to see them demonstrate improved outcomes consistent with the intent of the act. So we also want to note that as we are doing change management in partnership with counties, providers, and the community the BHSAA 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 DMCODS services from our county delivery systems. So these Medi-Cal services must be preserved and prioritized by all counties as a federal requirement, even as they are navigating other changes through implementing the BHSA. So the last part of this 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 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 coverage including for folks with the less significant behavioral health or mental health needs There is a proposed investment of million in total funds for clinic navigators to help guide Medi members through the work requirements process at application and renewal And there is also funding proposed for an outreach campaign at $17.5 million total funds, with half of that being general fund that would involve a marketing vendor to develop a tactical outreach strategy to raise awareness. We'd be developing social media toolkits for our providers, our managed care plans, tribal partners, coverage ambassadors to, again, better, more effectively reach and inform our members. This would also include earned media 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 non-specialty system and those who may be less likely to qualify for work requirement exemptions. We are also developing a comprehensive strategy to implement exemptions to the new HR1 work requirements with a key focus on exempting people with mental health and substance use disorder. So I 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 H.R.1. thus the focus of the committee's question on individuals with milder mental health needs makes sense and we are looking to these other strategies that I mentioned to support them one last opportunity I'd like to call out that we really hope can help Medi-Cal members with a range of needs stay enrolled through HR1 implementation this is a new proposal that we hope to include in our forthcoming section 1115 waiver renewal request to our partners at the Centers for Medicare and Medicaid Services. We will seek CMS approval to include employment supports as a county option but to be covered as a Medi benefit to address barriers to employment support sustained workforce participation consistent with the work requirements and promote economic stability more broadly among our Medi 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 receipts of core behavioral health services for that non-specialty 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 and partnership on these efforts to keep Californians with behavioral health needs enrolled in Medi-Cal and the broader efforts that I've spoken about to continually improve access and quality within our behavioral health delivery systems. Thank you and happy to hear questions.

Yeah so the population that is subject to or most impacted by the work requirements are going to be adults ages 19 to 64 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, et cetera.

The support platforms, yeah, for youth and maybe fee-for-service.

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 CWEB EHI 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.

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

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

Oops, sorry. 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 and are hearing from our providers. It is a lot in the prevention space since BHSA funds cannot be used for population-based prevention. But as Paula mentioned, you know, we've also heard counties looking, you know, some of these providers also provide early intervention services. So maybe it's, you know, helping educate them on what can be provided under early intervention, which is really focused more on the individual, but then perhaps supplementing with, like, opioid settlement funds, which can be used for, like, population-based prevention, such as campaigns, stigma reduction, opportunities like that. So it is a shifting landscape. 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, 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.

Yes.

I'm happy to take that one. I can say as of last March, we have granted out $5.8 billion of all of the BCHIP funds. So that was the initial investment of $1.7 billion and then with the addition of the $4.4 billion of the bond. So in March, we did the bond round too. But altogether we have funded 437 infrastructure projects which is creating an expansion of 546 either brand new behavioral health facilities or current facilities that are like expanding a wing or some type of access That's creating over 9,553 new residential beds. So that's for mental health and or substance use disorder. And then over 47,000. Those are.

Mental Health Rehabilitation Center or Psychiatric Residential Treatment Facility, which is a youth-focused setting. Yeah, or like SUD, Substance Use Disorder Residence. That I know.

Because it's over 20 different facility types, but also like peer respite. So all across the care continuum.

like someone coming in for the day, day treatment type services.

We sure do.

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 million that we did with our tribes just for the bond alone. And I have to say with our bond round, too, 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 percent 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.

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, you know, that is done, then they enter into contract. I can say, because one of your earlier questions is, you know, what do we have going? What have we actually done? But to date, we have 36, I'm sorry, there's 27 open projects that have 38 behavioral health facilities that are expanded already. So as of right now, we have 430 beds in operation and over 4,000 new outpatient treatment slots. And that increases every day. I'm actually going to a grand opening tomorrow in Santa Barbara County for a wellness center. So we are making progress in this space. There have been some issues with cost overruns just because of inflation and things that we couldn have predicted when we made these initial awards But all the projects are responsible for cost overruns And have we done an equitable distribution geographically We have We, a few things, too, is we did have with the bond a requirement to award counties at least $1.5 billion, which we exceeded, so that was a statutory requirement. And we also had to do a tribal investment of $30 million, so we've met those requirements. And we have a great map on our website that shows the equitable distribution because we did it geographically because we understood that some of our more rural partners may not put in, you know, have the bandwidth to put in an application as, you know, some for-profit organization that might hire a grant writer. But you'll see across we have a really great distribution. The only other thing I 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 an example, Glenn 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. So we're super excited about, like, we're hitting these great areas of needs. And then we also have, I'm really excited about this in Kern County, our first Fathers with Children SUD residential program as well. So we're across the state. We've really looked at the geographic need, but also really look closely at access needs as well.

So we, with our original B-CHIP dollars, the $1.7 billion, we did five rounds. They were smaller. Our first was we had to do $150 million for mobile crisis. All of that funding has been awarded. We're on that later. Yeah. We'll talk about that later. Round two was a planning grant, and we really looked through that planning grant process. That was for our counties and tribes, and that's actually helped award a lot of funds later. Rounds three was launch ready, four was children, and then five was crisis. And then the bond, we had just two rounds, the first $3.3 billion,

Okay. Okay, thank you. I have nothing else on this. We're going to move on to issue number nine. And before we get to our mini panel on this, I'll have the department first just do their presentation. Thank you.

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

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

$0.30. $0.30.

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

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 988. And once we do that, the statute would allow us to use the 988 fund to fund those.

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

I would just like to point out that I'm 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.

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

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

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

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

I would anticipate or I would 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.

It's like we're in commitment. We are fully committed to the two pieces, someone to contact and how will someone respond to them.

Step two is a crucial part of what the department is saying that they're in commitment to.

And step two, I think, like I mentioned, is a crucial part to getting the continuum of care.

Is that looked at as a waste? 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, you know, these decisions are made sort of looking across budget and spending priorities. And this is the proposal at this time. DHCS certainly is committed to working with counties to figure out what are the avenues for both continuing these services and then strengthening the additional crisis response services that we mentioned that will continue to be required under Medi-Cal so that we can maximize whatever resources we can.

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

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

So historically under the, yeah, I would need to defer to Department of Finance for that. So the 2022 Budget Act authorized one-time funding of $1.4 billion general fund over five years for mobile crisis through March 30, March 2027.

You're correct.

That's half of the fiscal year.

So we have in the current budget, right, assumes the enhanced federal match continues through December. and then there is a three-month period until that March 31st date where the budget proposes use of 988 funds Oh so it does propose I apologize So it does propose So that where I getting the April Yes And then technically you know without the TBL the benefit would sunset as of April 1st

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

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.

They have the capacity. So our funding, again, is consistent with what their current capacity is.

and also to be able to meet answer rates at a target rate that is expected from SAMHSA, which is greater than 90%. Their funding requests would be consistent with that. And also their response times. So right now SAMHSA mandates that across all contacts, so chats, texts, and calls, the answer response rates have to be greater than 90% for 15 seconds, so responding within 15 seconds, and then 95% would be 20 seconds.

SAMHSA's, yeah, guidance. SAMHSA, sorry, guidance.

Correct, exactly.

Or into account.

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.

Correct, yes.

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

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 that result through 988. It will help us monitor their performance on the indicators that Ivan just talked about, give us better data and better oversight effectively.

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

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, etc. So we have, you know, we do have a lot of...

Yes. Yes, it's not interchangeable.

So, you know, to answer your question, I mean, I think we would hope that there will be ways to continue funding this response. And we will also need to look, as mentioned, at other crisis services and continued investment in those services. And we will need to monitor, right? Are we seeing performance indicators that are concerning, increased use of other crisis services, increased hospitalizations, et cetera? And those are the kind of things that the state can take into consideration in the future as we look at how to prioritize funding and where to invest in our system. Okay. And also just noting that for those counties that do not opt into the mobile crisis benefit, they would still be able to continue to bill crisis intervention services.

Oh, we are live. All right. Thank you, Chairman Javar. I appreciate the opportunity to speak today. Of course, you know my name is Elise Jones. I've been serving as the director of Lake County Behavioral Health since the fall of 2023, which in dog years is a long time. I joke about that. In Lake County, we're a population of about 67,500 people, 68,000, very rural, big lake in the middle of it, very hard to get around. Unfortunately, we don't have a ferry that goes across the lake at this time, although that was an idea of our mobile crisis team. We currently operate one county-operated mobile crisis team. we are on staff 24-7, 365 days a week. That is a team of a minimum of two people responding. We also have our own dispatcher, if you will, to route calls. In calendar year 2025, we received approximately 5,664 crisis calls, and we conducted 1,305 field responses. About 83% of those field responses were resolved safely in the community without needing a higher level of care. That means people were stabilized through de-escalation, clinical assessment, safety planning, linkages to services, and follow-up without defaulting to emergency department, hospitalization, or law enforcement response. We did receive $1 million in 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 if we can't de-escalate over the phone, which we do successfully a lot of the time, by the way, crisis planning, warm handoffs, referrals, and follow-up.

Thank you for having me here today. My name is Nadia Pravara. 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 million of BCHIP funding to add 18 additional mobile crisis teams and expand our services countywide. The mobile crisis service also became a Medi-Cal benefit, signaling to us the state's commitment to sustaining these life-saving services. Locally, we took the opportunity to continue expanding the services into our K-12 schools, colleges, and to universities. And over the last 18 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 million 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 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 2% requiring law enforcement intervention. Half of all calls that we receive in a field intervention are stabilized in the field. And our program is focused on supporting Medi-Cal beneficiaries with over 80% of the clients being medical eligible. Mobile crisis services are also an entry point into the system. Nearly 60% of people serve through these crisis services receive a behavioral health service within 30 days. Additionally, they also can determine if somebody meets an involuntary hold criteria with about 16% of interventions resulting in a 5150 hold. But the community benefit is so much larger. Over 80% of the encounters are diverted from costly emergency depart visits. Our law enforcement partners benefit as well. About 18% of the mobile crisis referrals are diverted from law enforcement intervention. So law enforcement officers instead are able to respond to real emergencies. Since 2022, 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 counties lose state funding? In San Diego, it will 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 a revenue of approximately $15 million a year, including about $10 million in Medi-Cal and about five and a half of state general fund dollars. And the impacts of HR1, 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 benefit optional moves our system backwards. It will undo the progress we have 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 will 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 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.

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 40 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 25 years, our mobile crisis teams have helped young people and their families navigate profoundly difficult moments. We were there for Ana, 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 Ana 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 8-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 re-engage and worked with caregivers and school staff to plan to reduce future crises. And we were there for Damien, a 13-year-old foster youth whose caregiver feared the placement was about to disrupt after repeated nighttime conflicts, threats to runaway, and escalating emotional distress. Our team helped de-escalate in the moment, supporting both Damien and his caregiver, and built a plan that made it possible for him to stay safely in the home while his child and family team developed a longer-term plan. I'm here today to advocate for kids like Anna, Nina, and Damien, and to strongly urge the legislature to reject the proposal to make mobile crisis an optional benefit. This vital service connects young people in crisis with teams of highly trained professionals who can respond in the community, 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 24-7 support. And in many places, especially rural counties where these services are needed most desperately, mobile crisis teams may completely disappear. That would be a devastating loss. We should be moving towards more community-based, specialized, and developmentally appropriate crisis response for youth, not away from it. This proposal would also have a direct impact on foster youth who receive mobile response services through the Family Urgent Response System. Last year, 23% of Seneca's mobile response services were provided to FERS-eligible foster youth and former foster youth. Seneca is the 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 24-7 community-based crisis intervention. If mobile response is made optional, FERS will be impacted too. For foster youth and caregivers, that will mean less support in critical moments when a young person's placement stability is at risk. We know that mobile response works. It's a proven prevention strategy. In Seneca's longest standing mobile response program, we stabilize 86% of young people who receive an in-person visit, diverting them from a potentially traumatic ER visit, inpatient psychiatric care, or law enforcement questions. contact. We also provide follow-up support, connect youth to ongoing services, and help them step down from higher levels of care, often for 30 to 60 days following the initial crisis or referral. This is one of the most important prevention tools we have, reducing reliance on settings that are more restrictive, more disruptive, and more expensive. Cutting mobile crisis response does not eliminate crisis. It just shifts the cost and management of behavioral health crises to county systems who are already struggling with the financial constraints already discussed today. It also shifts the cost in management to resource-stretched law enforcement agencies and emergency rooms that are designed to address acute physical health crisis. California has made such extraordinary progress building out this critical part of our community-based crisis continuum, and we cannot go backwards now. I respectfully urge the legislature to reject this proposed change and maintain the statewide mobile crisis benefit. For young people and foster youth in particular, mobile response is not optional. It's one of the most effective and important programs we have in California. Thank you.

Chair Menjivar and subcommittee members, my name is Dr. Jana Lord, and I'm the chief operating officer of Sycamores. I oversaw the launch and sustainability of the 988 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 988 crisis policy advisory group. For 124 years, Sycamores has been committed to the well-being of children, adults, families, and communities throughout Southern California. In fiscal year 24-25, Sycamores served over 37,000 individuals across our programs in two counties. Sycamores' 988 mobile crisis teams are responsible for the majority of Los Angeles County, with 19 teams that operate during the week from 4 p.m. until 8 a.m. and 24 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 6 p.m. until 8.30 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 988 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 support 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 HR 1. 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 de-escalate 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 48 hours after the in-person encounter to all community members. This is to ensure that all barriers for follow-up care are removed. From July 1st of last year, 25, through March 31st of this year, 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 58% 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 988 mobile crisis teams responded to about 710 calls, of which 52% required hospitalization. In Riverside County, Sycamore's data reveals similar trends, yielding strong outcomes. During the same time frame, our mobile crisis teams conducted 1,723 in-person crisis assessments. Only 9% required law enforcement assistance to ensure the safety, both of our community members as well as our staff. And 33% 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 Sycamore's 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 mobile crisis team 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.

Thank you very much, Chair Mendevar 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 988 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, D.D. Hirsch and the other 10 988 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 988. 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 of 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 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 change 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 as affluent and maybe where the counties can't actually really financially support those mobile crisis teams.

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 the 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.

Thank you. Good afternoon, Chair Mendravar. Thank you for your attention to the sustainability of California's 988 system. My name is Narja Zahori Dillon, and I'm here as the president of 988 California, the Crisis Center Consortium, representing California's 11 988 Suicide and Crisis Lifeline Centers. I also run one of those centers in Alameda County. Our centers provide 24-7 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 988, the number of help seekers reaching out to us has consistently increased. Comparing January of 2025 to January of 2026, the incoming call volume to California's 988 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 youth suicide deaths ages 15 to 34 dropping 11 percent below projections. The 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 percent of texts 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 20 seconds. Most critically, the decrease of the 988 surcharge from $0.08 to $0.05 this year is extremely worrisome, considering what I just shared. AB 988 allows for a surcharge of up to $0.30. This dedicated source of funding gives California a chance to deliver on the promise of 988. at a time of numerous stressors to the broader behavioral health continuum. 988 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 20 years. We support the state's five-year 988 implementation plan but cannot achieve the comprehensive continuum of care without the strong foundation of 988 Center. The DHCS-BCP only adds $2 million for next year to the Centers directly. We urge the legislature to allocate the $105 million 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.

You gave some examples. You gave some examples in my district. But when they end up going, yeah, anybody. So for 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, rural basic level of care. That's not us. However, if they need to go to an acute psych and 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.

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 obviously law enforcement resources for us, too, for adults, at least in our system. They end up going to we have a county-operated psych hospital, and the cost per bed day there is like $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. And counties, if I can imagine preventing them from going to these locations is more cost efficient.

I would say absolutely. 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. Right now, there's a partnership with the federal government and the state.

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.

Can have counties considered being part of that match? 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. Also, it should be noted that counties with a lot of dish placements, those come right out of your realignment usually. And so we've seen that increasing as well, which is unfortunate. So we've also seen our realignment sources dwindle as a result.

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 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 Okay.

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 during working hours. And so fingers crossed that that's when you experience your crisis. And prior to, I can only speak for L.A. and Riverside counties, there were no mobile crisis teams in Riverside County that were operating PM as well as overnight. LA County, it was sparse, sparsely funded, and it was only until 2 a.m. in the morning. There might be like one or two teams. So the reality is that 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 in which are going to be rendered. You know, as 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.

Previous hospitalizations were from law enforcement or they had to go into the emergency rooms and sit there for hours. Sometimes in-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.

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.

So kind of the equation is in order to answer more contacts, we need more staff. 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.

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 the high 80s, 80% for California. For text is 40%. And that actually where most of that For who For text and chat Okay That where most hundred and five million honestly would go Texts and chats on average take about three times as long as a as a phone call A phone call on average is like 12 to 13 minutes. A text and chat is 43 to 45. That's interesting because I feel like that'd be faster.

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.

And the rapport building is different. You can't make the good sounds.

Oh, no, no. The length of the service.

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 for.

No. No, more people choose to call, actually. But not all California centers had text and chat capacity when 988 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 is 24-7. 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 backup centers.

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.

So the surcharge was reduced this year. It was $0.08 the first two years. It was reduced to $0.05. 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, or chat. At a time where the need is going up by more than 30% to reduce the surcharge seems incongruous.

Can I add as another 988 center, earlier you heard DHCS say that their budget request funds the 988 centers to their capacity. And it's kind of, 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 for us. It's very similar to 911. And those aren't just federal standards. It was said that these are SAMHSA standards. That's true, but there are 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 million more, actually, compared to last year, despite 30% volume growth increases. It's, like, so far off from where we need to be. Okay. Thank you so much.

So when we put together the BCP, we look at historical funding levels and try to take into account increased demands on capacity. But we don't, practically speaking through the budget process, have an opportunity to ask for anything or any number. So we are somewhat taking into account, again, what we've been able to fund historically and building from there rather than starting with where I think our partners started, which is what do they think they really need in 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 would like to improve as well. Ultimately, that is a Cal OES decision to, you know, in this case, lower the surcharge from $0.08 to $0.05.

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.

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.

Yeah, that's correct. If they're a Medi-Cal member, that emergency department encounter would be paid by Medi-Cal.

Yeah, and I think those are the that I alluded to earlier. We'll need to look at indicators, right? If we proceed this way to see how the crisis system is performing and what the impacts really are.

Yeah, I mean, I actually have some empathy to DHCS, right? They can only allocate to the 988 centers what they are given to allocate. Yes. You know, they're strong partners with the 988 centers, but the starting gate is way too low. So 30% volume increase this year to 988, 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 20 years' worth of data. So I think that, like, you know, because 988 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 988, says that the 988 centers have to be fully resourced first. And we want to 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. Thank you.

Marlies Prez, 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 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 1 passed, it established a revenue and stability workgroup. And the whole purpose of the workgroup 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 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 So counties have historically built up significant prudent reserves, but they did not draw on them. For example, during the 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. And part of that is the way the counties are allocated their funds. They have this trailer bill does not impact their reversion periods. So large 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 prudent reserve if they want. Having a prudent reserve is not mandatory. It is optional for counties.

So through these workgroup 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.

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 like 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.

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 a 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 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, 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.

Yes, Will owns the Legislative Analyst's 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 Prudence 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 to change the MHSA, Our office released an analysis kind of highlighting the revenue volatility of the millionaire's tax, which is 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 the revenues come in for this process every year Additionally our office found that prior to the changes under Proposition 1 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 proposal set forth within the workgroup 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 county expenditures on these programs, it doesn't necessarily account for large dips in revenue, for example. So that would be one area 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 bill as it currently sits would allow them to change in the future. While this may be helpful for flexibility, it kind of limits legislative oversight. So the legislature may consider requiring something like a 30-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.

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, 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 of 24, 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.

And they actually participated well and gave some great insights. I do recall that. Sorry about that.

So there were, first of all, I just want to accent what the LAO said about the volatility effect. 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 we 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 proposal that we did a lot of research on. Instead of lowering the prune reserves and having 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 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 also have to look at what we kind of consider a savings account of 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, you know, put a lot of flexibilities in place that helped the counties during that very obviously unexpected turn of events.

we landed on 20% and now we're bringing it down to 10% or it's 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

you know, we propose that. And I do want to also just say that when this proposition one language which was in development, this was a really sticky widget. That's why we put it aside, you know, brought this work group together because we recognized that we needed some time, you know, and some thought to be put into this. But with the 10% and looking at, once again, we looked at, we have, you know, 20 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 24 or 25, 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 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 still available Unlike when we were looking at locking this in the legislation, we didn't want to do that because we were concerned, you know, that we wouldn't be able to make this shift. So we're hopeful that this is, you know, what is needed. And once again, like I said, through all our different various analysis, this were the prudent 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.

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 of this year. And so counties would need to update through their annual. I'm sorry, 2026. 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 in effect in 27. But then the rest of the changes wouldn't go into place until the next three-year planning cycle. So our three-year planning cycles, this integrated plan starts in 26, ends in 29. So it would be that next cycle where that minimum expenditure level would all go into place. Sorry.

That's okay.

Yes. So, yes. So the next planning year cycle.

2930 is when our next, like, yeah, is for, yeah, for the next integrated plan cycle.

Sure. Why we landed on three? Yeah, so the main difference is it really just then puts less funding out 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.

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 money for services if you're looking at a five-year. Correct.

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.

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 end of 2023, ASAM replaced their third edition standards with the new fourth edition. And in the TBL, we propose 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 June 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 a thousand 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 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

Good afternoon, Chairman Javar. Michelle Cabrera with the County Behavioral Health Directors Association of California. I first want to thank the chair and staff for the 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 HR1, 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.

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 help to 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 that described today. The first care I got was in an ER, and 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 Worm Line, 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 988 addresses. We keep people out of crisis. We start those conversations. We allow people to learn about mental health, to explore it with us. When I was coming up, there were no conversations about it. 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.

I'm Mark Salazar, the CEO of the Med Health Association of San Francisco. I'm here to urge you to support the $6.5 million to restore the CalHop warm line and the Spanish warm line to 24-7 operations. At its peak, our warm line was taking or receiving 40,000 attempts to contact us. 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 24-7 with the Spanish bilingual warm line with it together. So thank you for your time.

My name is Divya 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 D.D. 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 the Senate Subcommittee No. 3's proposals for investments to protect the statewide Medi-Cal mobile crisis service, as well as the proposals for investments to increase 988 funding and to return the California peer-run warm line to 24-7 operation. All of these are critical to save vulnerable lives in California. We also want to thank the committee for including the list of programs that San Diego and Monterey 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 Menjavar, asked. Thank you so much.

Good afternoon, Mehran with Color Voices. So regarding issue eight, the restructuring of the behavioral health funding is significantly affecting peer-led organization. Calvoices is poised to lose $2.2 million in contract with Sacramento County in July 2026. We urge the legislator to direct the Department of Public Health to allocate BHSA population-based prevention program funding to prioritize peer-led organization whose contracts are being eliminated. as these cuts are significantly impacting services for medical enrollees with severe behavioral health condition. Regarding issue 9, 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 certified medical peer support specialists to do HR1 outreach as they are important trusted of the community Thank you

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.

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 8,000 people call about suicide. Of those 8,000 calls, only 1% 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, Madam Chair. Brendan McCarthy with CSAC. We appreciate your comments on the challenges that counties are facing with HR1 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 bill. Thank you.

Caroline Grinder on behalf of the League of California Cities. CalCities 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.

Good afternoon, Madam Chair. Mike Sharif 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 988 crisis system, but the 988 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 a very crisis continuum the state has worked to build. We strongly urge you to reject this proposal. Thank you.

Good afternoon, Josh Goger 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 to $5 million, and Riverside is concerned it will impact their efforts that have led to diverting 70% of crises from law enforcement and hospitals. Thank you.

Madam Chair, I'm Daryl Hamilton with Kingsview. To comment on Agenda Item 4260, our agency provides 988 services for Sanislaw, Merced, Mariposa, Madera, Fresno, Kings, and Tulare counties. Kingsview is a member of the 988 California, the consortium of California's 11 988 crisis centers, which have responded to 2.8 million help seekers since 2022. Today we ask you to consider our budget request to ensure all Californians in crisis have access to timely care that they need. As you already heard, California's 988 centers can only respond to 40% of incoming text and chats due to funding constraints. Our text and chat team is currently available 14 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. Thank you.

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. A lot of our members are family members of people with a mental illness. We surveyed our members to ask them, Have you had interactions with mobile crisis? What's that been like for you? And just briefly in the 20 seconds I have here, I just wanted to share a quick snapshot that one family shared with us that 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 time.

Darby Kernan on behalf of two clients. On Issue 9, 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 8, 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.

Good afternoon, Madam Chairwoman and fellow social worker. I'm Dr. Lisa Pyrenberland, the President and CEO of Parents Anonymous, Inc., who runs the only California Parent and Youth Helpline 24 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 they are trans or they are facing immigration issues or fires in the L 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 going to 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 Parenting Youth Helpline with the support of the governor during COVID in 2020. We're coming to the sixth anniversary, actually, and we need this continued $5 million a year for the next three years to continue to serve California and save lives. Thank you.

Angela Herrera, Parents Anonymous. I'm a parent advocate. Watching my mom go through stage 4 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 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 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.

George Cruz on behalf of the California Behavioral Health Association. CBHA represents providers across California, including the one-third of 988 call centers. California's 988 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 to increase 9-8 funding to meet the growing demand, and we urge legislators to support it as well. Thank you so much.

Good afternoon, Chair. My name is Aston Georgiou 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.

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... way to die due to medication change. And my daughter was struggling with youth partner violence. No parent should face something like this, but we did, and so did my children. I'm sorry. It's 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 life-saving. It's like no other. Thank you.

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, specifically, or very few, are calling out specific services. And many of the evidence-based programs that serve older adults are 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. Thank you.

My name is Christiana Bosch I am the director for Bucklew Programs 988 Call Center Our center provides service to Marin Sonoma Lake and Mendocino counties and I 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 the 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.

Madam Chair and member, here to comment on issue number nine. I'm Christy Gonzalez with Well Space Health. We provide 988 suicide prevention services to 30 counties in California, and we're a member of the 988 California Coalition of Crisis Centers. We ask you to review the 988 California letter dated April 17th regarding the trailer bill language on AB 988. Specifically, we are requesting adding 988 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 988 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.

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 crisis continuum. About 44% of adults who use mobile crisis services engage mental health treatment within 30 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 access to care. And so we cannot afford to dismantle a system that is already saving life and improving outcomes for many Californians.