The Honorable Mia Bonta Chair, Assembly Health Committee 1020 N Street, Room 390 Sacramento, CA 95814
RE: Support for AB 512 (Harabedian)
Dear Chair Bonta,
Mental Health America of California (MHAC) is pleased to support Assembly Bill 512 (Harabedian), legislation that would shorten prior authorizations for health care services to no more than 48 hours for standard requests or 24 hours for urgent requests.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. Prior authorization procedures can create significant barriers to access voluntary mental health and substance use services.
The prior authorization process requires providers to obtain approval from health plans before delivering certain services or support, including mental health care. However, this process can take anywhere from one to five days. This delay can create unnecessary barriers to accessing voluntary services, services that are intended to support individuals before they reach a point of crisis. This bill ensures that care is delivered promptly by reducing delays for both standard and urgent requests.
It is for these reasons MHAC supports AB 512 (Harabedian) and asks for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any behavioral health legislation, please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
The Honorable Mia Bonta Chair, Assembly Health Committee 1020 N Street, Room 390 Sacramento, CA 95814
RE: Support for Assembly Bill 510 (Addis)
Dear Chair Bonta,
Mental Health America of California (MHAC) is pleased to support AB 510 (Addis), legislation that ensures appeals or grievances related to denied healthcare services are reviewed within 2 business days by a licensed physician or a qualified healthcare professional with expertise in the relevant area. Additionally, if these timelines are not met, the request would be automatically approved.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy.
Individuals can experience a range of mental health or substance use challenges, and when they seek appropriate support or services through their health insurance, coverage denials can create serious gaps in care. While health plans offer grievance processes for enrollees to challenge these denials, the grievances are sometimes reviewed by general physicians or health administrators who may lack the specialized expertise needed to assess mental health or substance use conditions. This lack of competency can lead to continued denials, delaying or denying access to necessary care. In 2016, the Department of Managed Health Care reported that enrollees who requested an Independent Medical Review (IMR) after a health plan grievance was unresolved received the requested health care services in nearly 69 percent of cases.[1]
By ensuring competent review of coverage denials in the grievance process, this bill will help reduce gaps in care and reduce the need for IMRs. It is for these reasons MHAC supports AB 510 (Addis) and asks for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any behavioral health legislation, please feel free to contact me at hstrunk@mhac.org or reach out to our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
The Honorable Caroline Menjivar Senate Health Committee 1021 O Street, Room 3310 Sacramento, CA 95814
RE: MHAC Support for Assembly Bill 348 (Krell)
Dear Chair Menjivar,
Mental Health America of California (MHAC) is pleased to support Assembly Bill 348 (Krell), legislation that defines presumptive eligibility for full-service partnerships (FSPs) to include individuals with a serious mental illness (SMI) who are experiencing unsheltered homelessness, transitioning to the community after six months or more in a secured treatment facility, has been detained five or more times pursuant to Section 5150 over the last five years, or transitioning to the community after six months or more in the state prison or county jail.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues. The people and communities we aim to serve include those of all ages; sexual orientation, gender identity or expression; language, racial and ethnic backgrounds, national origin, and immigration status; spirituality and religious affiliations; or socioeconomic status. FSPs align with this mission by offering flexible, voluntary services with a “whatever it takes” approach to support individuals living with an SMI.
FSPs offer wraparound, whole-person care that helps reduce homelessness, improve mental health outcomes, lower emergency room visits, reduce justice involvement, and increase community integration. By establishing presumptive eligibility, AB 348 (Krell) removes unnecessary barriers to care and ensures timely access to vital services. This bill is especially applicable to individuals with an SMI who need step-down levels of care after leaving locked institutional treatment facilities, incarceration, or while experiencing homelessness. It also ensures eligibility even when the primary diagnosis is a substance use disorder with a co-occurring serious mental illness.
Each eligibility criteria represents a significant life event for someone living with an SMI. Being properly supported with an FSP can mark a significant turning point in one’s recovery journey. It is for these reasons MHAC supports AB 348 (Krell) and asks for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any behavioral health legislation, please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
The Honorable Angelique Ashby Senate Business, Professions, and Economic Development Committee 1021 O Street, Room 3320 Sacramento, CA 95814
Re: MHAC Support for AB 529 (Ahrens)
Dear Chair,
Mental Health America of California is writing in support of AB 529 (Ahrens), legislation that would allow the California State Board of Pharmacy to waive provisions of the Pharmacy Law for up to 120 days instead of 90 days after the end of a declared federal, state, or local state of emergency. This would allow mobile pharmacies or clinics to continue severing impacted areas and ensure continuity of services.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues. The people and communities we aim to serve include those of all ages; sexual orientation, gender identity or expression; language, racial and ethnic backgrounds, national origin, and immigration status; spirituality and religious affiliations; or socioeconomic status. When natural disasters impact whole communities, access to vital mental health and substance use services must be prioritized to prevent disruptions in care and provide hope for restoration.
A state of emergency can arise in various forms, including epidemics, power outages, extreme weather, and natural disasters such as floods, earthquakes, and wildfires. During such emergencies, the availability of resources and public services becomes scarce, such as access to healthcare services and medication. During times of great stress, Individuals may develop, or experience heightened, mental health challenges increasing the need for these vital services.
While the Board of Pharmacy may currently waive provisions of the pharmacy law for up to 90 days after the end of a state of emergency to allow mobile clinics and pharmacies to operate, it can take more than 90 days to rebuild a community and for any sense of normalcy to return. This bill would allow for an additional 30 days for a total of 120 days expanding access to care and medications as communities transition from crisis intervention to rehabilitation.
For these reason MHAC supports AB 529 (Ahrens) and asks for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any behavioral health legislation, please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
The Honorable Jesse Arreguín Senate Public Safety Committee 1020 N Street, Room 545 Sacramento, CA 95814
RE: Support for Assembly Bill 1387 (Quirk-Silva)
Dear Chair Arreguín,
Mental Health America of California (MHAC) is pleased to support AB 1387 (Quirk-Silva), legislation that would establish mental health multidisciplinary personnel teams, to facilitate the identification, assessment, and linkage of a justice-involved person diagnosed with a mental illness to supportive services while incarcerated and upon release from county jail.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues. The people and communities we aim to serve include those of all ages; sexual orientation, gender identity or expression; language, racial and ethnic backgrounds, national origin, and immigration status; spirituality and religious affiliations; or socioeconomic status.
Transition services from institutions for mental diseases, jails, and mental health rehabilitation centers help ensure that individuals with mental health challenges won’t experience any disruptions in care and can be safely integrated into their community. These services help individuals develop independence and can reduce cycling between California’s health crisis and justice system. Justice involved individuals have significant challenges reintegrating into their community due to the stigma of being formerly incarcerated and the lack of assistance to identify the services they need. Without proper support, individuals can fall through the cracks of California’s safety net programs, experience additional health challenges leading to more health crises, and potentially be incarcerated again.
This bill ensures a designated mental health multidisciplinary personnel team is established to provide transitional services and support that can prevent mental health crises from developing and promote long-term wellness goals. To accomplish these goals, services include but are not limited to healthcare, housing, and other social services.
It is for these reasons MHAC supports AB 1387 (Quirk Silva) and asks for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any behavioral health legislation, please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
Marc Berman Chair, Assembly Committee on Business and Professions 1020 N Street, Room 379 Sacramento, CA 95814
Angelique Ashby Chair, Senate Committee on Business, Professions, and Economic Development 1021 O Street, Room 3320 Sacramento, CA 95814
RE: Joint Sunset Review – Board of Psychology – Exception to Psychotherapist-Patient Privilege for Board Investigations—OPPOSE
Dear Chair Berman and Chair Ashby,
Mental Health America of California (MHAC) would like to express opposition to the California Board of Psychology’s proposed exception to the psychotherapist-patient privilege in Board investigations (Proposal #1 of Section 10 of the Sunset Review Report, page 97) and request that proposal not move forward. The proposal would establish a psychotherapist-patient privilege exception for Board investigations.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues. The people and communities we aim to serve include those of all ages; sexual orientation, gender identity or expression; language, racial and ethnic backgrounds, national origin, and immigration status; spirituality and religious affiliations; or socioeconomic status. Our communities rely on the expectation of privacy when accessing mental health care.
Currently, if a patient refuses to disclose records in a Board investigation, the Board has recourse to obtain the records through a subpoena and obtain a civil court order to enforce the subpoena. This ensures that the Board demonstrates compelling interest that the disclosure of such records is relevant and material to the issue. This court process offers the Board an avenue to obtain records while upholding the psychotherapist’s duty to patient privilege and protecting the patient’s constitutional right to privacy.
Confidentiality is essential to successful psychotherapy because it allows for open dialogue between the Psychologist and the patient on extremely personal and sensitive issues. Patients rely on the expectation of privacy every time they attend a therapy session, and without the guarantee of privacy, patients will be less likely to be forthcoming with their therapist and possibly be less likely to seek care.
In addition, this proposal has the potential to severely undermine the quality and effectiveness of psychotherapy. If Psychotherapists fear that their client records could be seized without proper protections, this could result in less than accurate and potentially reductive work products.
The Board has reported that over the last four years it has had to close only three cases due to an inability to access records. The low number of cases being closed does not provide any significant or compelling arguments for a psychotherapist-patient privilege exception. It is for these reasons that MHAC asks you not to move forward with the Board’s proposal. If you have any questions, or if MHAC can provide any assistance on this issue or any behavioral health legislation, please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
In Community,
Heidi L. Strunk President & CEO
Cc: Honorable Members, Assembly Business and Professions Committee Honorable Members, Senate Business and Professions and Economic Development Committee Kaitlin Curry, Consultant, Assembly Business and Professions Committee Anna Billy, Consultant, Senate Business and Professions and Economic Development Committee
The Honorable Jesse Gabriel Assembly Budget Committee 1021 O Street, Suite 8230 Sacramento, CA 95814
The Honorable Dawn Addis Assembly Budget Subcommittee 1 on Health 1021 O Street, Suite 4120 Sacramento, CA 95814
The Honorable Scott Wiener Senate Budget and Fiscal Review Committee 1021 O Street, Suite 502 Sacramento, CA 95814
The Honorable Akilah Weber Pierson Senate Budget Subcommittee 3 on Health and Human Services 1021 O Street, Suite 7310 Sacramento, CA 95814
RE: Opposition to Cuts in Governor Newsom’s May Revise Budget Proposal
Dear Chairs Wiener, Gabriel, Addis and Weber Pierson,
Mental Health America of California (MHAC) is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues. The people and communities we aim to serve include those of all ages; sexual orientation, gender identity or expression; language, racial and ethnic backgrounds, national origin, and immigration status; spirituality and religious affiliations; or socioeconomic status.
As California faces a staggering $12 billion budget deficit, the state must prioritize and preserve the vital mental health and substance use supports and services that Californians depend on. These supports and services have proven to be effective in reducing long term state costs related to criminal justice involvement, emergency hospitalization, and institutionalization. MHAC opposes the following proposals in Governor Newsom’s May Revise and urges action from the Assembly and Senate to preserve funding for the following supports and services:
Peer Support Personnel Training and Placement Program This program provides grants to community-based organizations to train and place individuals with lived experience, or peers, to work as Medi-Cal Certified Peer Support Specialists. Peer Support Specialists provide a wide range of services including crisis support, individualized wellness planning, and trauma informed care. In addition to being an evidence-based practice, it is essential to address the state’s behavioral workforce shortage and meet the growing demand for mental health and substance use services. MHAC requests an annual apportionment of $14 million a year, $4 million from the Behavioral Health Services Fund, and $10 million from the General Fund to continue producing trained behavioral health professionals.
California Peer-Run Warm Line The California Peer Run Warm Line is a 24/7 telephone and text line that provides peer-led, non-coercive, and stigma-reducing support that addresses a wide range of challenges, including anxiety, depression, and substance use. 77% of users surveyed indicated a reduced likelihood of needing emergency services such as 911, suicide prevention, and emergency room visits. These services provide an alternative to costly crisis intervention services and can ensure individuals of all demographics can be served. The CA Peer Run Warm Line continues to see a rise in calls and to meet the rising demand the state must fully fund it. MHAC requests $25 million annually for FY25-26 and FY26-27 in order to continue this vital 24/7 support.
Mental Health Wellness Act (MHWA) The current proposal eliminates $20 million in annual grant funding that would improve access to and expand capacity for vital behavioral health services. These grants would provide needed funding for the following vital behavioral health supports and services:
Peer Respites
Peer Respite is a voluntary service that provides community-based support to people experiencing or at risk of experiencing a mental health crisis. Services include but are not limited to peer support, linkages to mental health support or resources, short-term overnight stays, and individualized care support planning. Peer Respites are effective in reducing hospitalization and incarceration, resulting in improved long-term health outcomes and reduced costs to the state’s behavioral health system. Sustaining and growing Peer Respites also supports the development of the California behavioral health workforce, aligning with the state’s investments in Peer Support Personnel.
Full-Service Partnerships (FSP)
FSPs offer person centered wrap around support with a “whatever it takes” approach for people with severe mental health challenges, prioritizing those who are unhoused, have a history of being justice involvement, or have experienced multiple hospitalizations. In 2023, the Behavioral Health Services Oversight and Accountability Commission reported that FSP participants experienced a 54% reduction in emergency room visits, a rapid reduction in emergency mental health services, and a 47% reduction in justice involvement. As the Behavioral Health Services Act funding has been reduced for FSPs, MHWA funding is now essential to support technical assistance and capacity building that strengthens and improves service delivery.
Gender Health Equity Section (GHES) at the Department of Public Health GHES develops programs and policies intended to eliminate gender-based health disparities in California through the following grant programs:
The Lesbian, Bisexual, Transgender & Queer (LBTQ) Unit, which centers community solutions and leadership to eliminate health disparities and research gaps impacting diverse LBTQ Californians.
The Wellness & Equity Unit, Transgender, Gender Diverse and Intersex (TGI) Unit which exists to elevate health equity issues experienced by TGI people caused by systemic discrimination in healthcare settings, housing, employment, and public accommodations.
Wellness and Equity Unit, and the Reproductive Freedom and Abortion Access (RFAA) Unit which addresses issues related to reproductive freedom and justice, abortion access and focus attention on California communities who historically and/or systemically experience inequities related to access to related services.
The proposed budget seeks to reduce $14 million in local assistance that supports these LGBTQ+ and reproductive health programs. LGBTQ+ individuals are experiencing heightened anxiety, depression, and risk of suicide due to the current political climate, most notably the attacks on the transgender community. The transgender community faces discriminatory barriers to housing, healthcare, and public facilities creating hostile and unwelcoming environments. Preserving funding for these programs is essential to addressing the institutional gaps in care for the LGBTQ+ community and improving long term health outcomes.
Phase II of the California Reducing Disparities Project (CRDP) CRDP is a statewide mental health initiative targeting five populations in California that have been historically unserved, underserved, and inappropriately served: African Americans, Asians and Pacific Islanders (API), Latinos, Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ), and Native Americans. Grants are awarded to local community-based organizations (CBO) to help serve these populations and provide an analysis of solutions for reducing mental health disparities. The May Revise proposes reverting $15.8 million previously allocated to this initiative, threatening to stop funding to CBOs currently in progress of executing their awarded grant. In addition to disrupting care being provided, this budget reversion would threaten the existence of these CBOs and their programs.
Individuals 19 and Older with Unsatisfactory Immigration Status (IUIS) The proposed budget freezes new enrollment into Full-Scope Medi-Cal, enacts a $100 monthly premium on current enrollees, and lowers reimbursement rates to federally qualified health centers (FQHC) for services to IUIS. This proposal would prevent one of our most underserved populations from accessing vital behavioral health services. Additionally, lower reimbursement rates to federally qualified health centers would not just impact services to IUIS, but would also impact FQHC’s fiscal operation, thus impacting the services it provides to their entire community.
Medi-Cal Asset Limits This policy would reinstate Medi-Cal asset limits (which were removed by the Legislature in 2024) for seniors and people with disabilities, resulting in individuals from this population with more than $2,000 in assets or a couple with more than $3,000 in assets to be ineligible for Medi-Cal. This is a significant reduction that would prevent many of those in the most need of assistance from accessing vital behavioral health supports and services.
MHAC is committed to the mental health and wellness of all Californians regardless of immigration status, race, ethnicity, sexual orientation, or gender. Governor Newsom’s May Revise proposes significant cuts to investments in mental healthcare that will negatively impact diversity, equity, and inclusion. These proposed cuts will strip essential services from historically underserved communities, pushing more individuals to experience impacts to their behavioral health and deepening health disparities.
Without continued investments in voluntary, culturally responsive, community based mental health and substance use supports and services, California will overburden our emergency systems, increasing hospitalization, institutionalization, and the criminalization of individuals with unmet behavioral health needs.
Mental Health America of California urges you to reject the proposed cuts and preserve funding for mental health support and services that meet Californians where they are. If you have any questions, or if MHAC can provide any assistance on this budget please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
In Community,
Heidi L. Strunk President & CEO
CC: Paula Villescaz, Deputy Legislative Affairs Secretary, Office of Governor Gavin Newsom Richard Figueroa, Deputy Cabinet Secretary, Office of Governor Gavin Newsom Michelle Baass, Director, California Department of Health Care Services Dr. Erica Pan, Director, California Department of Public Health Kendra Zoller, Deputy Director of Legislative & External Affairs, Commission for Behavioral Health
Marc Berman Chair, Assembly Committee on Business and Professions 1020 N Street, Room 379 Sacramento, CA 95814
Angelique Ashby Chair, Senate Committee on Business, Professions, and Economic Development 1021 O Street, Room 3320 Sacramento, CA 95814
RE: Joint Sunset Review – Board of Psychology – Exception to Psychotherapist-Patient Privilege for Board Investigations—OPPOSE
Dear Chair Berman and Chair Ashby,
Mental Health America of California (MHAC) would like to express opposition to the California Board of Psychology’s proposed exception to the psychotherapist-patient privilege in Board investigations (Proposal #1 of Section 10 of the Sunset Review Report, page 97) and request that proposal not move forward. The proposal would establish a psychotherapist-patient privilege exception for Board investigations.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues. The people and communities we aim to serve include those of all ages; sexual orientation, gender identity or expression; language, racial and ethnic backgrounds, national origin, and immigration status; spirituality and religious affiliations; or socioeconomic status. Our communities rely on the expectation of privacy when accessing mental health care.
Currently, if a patient refuses to disclose records in a Board investigation, the Board has recourse to obtain the records through a subpoena and obtain a civil court order to enforce the subpoena. This ensures that the Board demonstrates compelling interest that the disclosure of such records is relevant and material to the issue. This court process offers the Board an avenue to obtain records while upholding the psychotherapist’s duty to patient privilege and protecting the patient’s constitutional right to privacy.
Confidentiality is essential to successful psychotherapy because it allows for open dialogue between the Psychologist and the patient on extremely personal and sensitive issues. Patients rely on the expectation of privacy every time they attend a therapy session, and without the guarantee of privacy, patients will be less likely to be forthcoming with their therapist and possibly be less likely to seek care.
In addition, this proposal has the potential to severely undermine the quality and effectiveness of psychotherapy. If Psychotherapists fear that their client records could be seized without proper protections, this could result in less than accurate and potentially reductive work products.
The Board has reported that over the last four years it has had to close only three cases due to an inability to access records. The low number of cases being closed does not provide any significant or compelling arguments for a psychotherapist-patient privilege exception. It is for these reasons that MHAC asks you not to move forward with the Board’s proposal. If you have any questions, or if MHAC can provide any assistance on this issue or any behavioral health legislation, please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
In Community,
Heidi L. Strunk
President & CEO
Cc: Honorable Members, Assembly Business and Professions Committee Honorable Members, Senate Business and Professions and Economic Development Committee Kaitlin Curry, Consultant, Assembly Business and Professions Committee Anna Billy, Consultant, Senate Business and Professions and Economic Development Committee
The Honorable Scott Wiener, Chair Senate Budget Committee 1020 N Street, Room 502 Sacramento, CA 95814
The Honorable Jesse Gabriel, Chair Assembly Budget Committee 1021 O Street, Suite 8230 Sacramento, CA 95814
The Honorable Laura Richardson, Chair Senate Budget Subcommittee No. 5 1020 N Street, Room 502 Sacramento, CA 95814
The Honorable James Ramos, Chair Assembly Budget Subcommittee No. 6 1021 O Street, Suite 8230 Sacramento, CA 95814
Re: Proposition 36 Behavioral Health Treatment Implementation Recommendations
Dear Chairs Wiener, Gabriel, Richardson and Ramos:
The below signed coalition of advocates representing behavioral health treatment providers and advocates for safe and healthy communities, respectfully request the Legislature provide funding to expand the capacity to deliver more behavioral health treatment, including for individuals charged with treatment-mandated felony offenses created by Proposition 36. As organizations dedicated to improving behavioral health outcomes across the state, we recognize the urgent need to provide individuals charged with treatment-mandated felonies and those voluntarily seeking treatment and supportive services that often serve as pathways to treatment the comprehensive and accessible treatment and support they need and deserve.
In November, voters sent a clear message that treatment must be part of a successful public safety strategy. Ensuring the availability of appropriate, on-demand behavioral health services for anyone seeking them is essential to meeting needs created by Proposition 36 and reducing entry into the criminal legal system. To do so, we recommend the Legislature take the following actions:
Invest $105 Million in Behavioral Health Treatment for Proposition 36: California’s behavioral health treatment system, particularly for substance use disorders, remains under-resourced and oversubscribed. Without additional funding, many individuals eligible for treatment under Proposition 36 will be unable to access the care they need. There is a significant need for substance use disorder treatment capacity across the continuum, particularly acute need for residential treatment capacity given the current wait times can be weeks or even months long.
While it is difficult to estimate the treatment needs under Proposition 36 only a few months into implementation, based on the Judicial Council’s Proposition 36 survey, we anticipate an additional $105 million in treatment investments is needed.1 This investment is critical to ensuring that treatment programs statewide can meet demand, improve outcomes, and provide a path of recovery and opportunity that ultimately create safer communities.
Build Out the Forensic Behavioral Health Continuum of Care with Focused Workforce and Infrastructure Investments: California faces a devastating behavioral health workforce crisis. Estimates from the Steinberg Institute suggest that we need to add 375,000 workers over the next decade to meet the demand for care. This estimate does not include the increased need for services being driven by Proposition 36. While the state is poised to invest billions into the build-out of new capacity through the Bond BHCIP and Proposition 1 workforce investments, it is important that a portion of these dollars are prioritized for the buildout of a forensic behavioral health continuum of care with a focus on individuals in the criminal legal system who have behavioral health needs.
Ensure Behavioral Health Clinicians Perform Evaluations and Make Level of Care Recommendations: Clinical evaluations and decisions regarding the appropriate level of treatment for individuals should be made by qualified behavioral health clinicians working within the county behavioral health safety net and using the criteria and guidelines set forth in the most recent versions of treatment criteria developed by the nonprofit professional association for the relevant clinical specialty, such as the ASAM criteria for substance use disorders. This will ensure that those mandated to treatment under Proposition 36 receive care that is evidence-based, appropriately tailored to their individual needs, and in compliance with insurance-based medical necessity requirements.
Direct Treatment Funds to State and Local Behavioral Health Agencies: To maximize the effectiveness and accountability of Proposition 36 funding, all treatment dollars should be allocated to appropriate state and local behavioral health entities, specifically the Department of Health Care Services and county behavioral health departments. These entities have the expertise necessary to deliver high-quality treatment services and oversee program implementation.
Require Reimbursement by Commercial Insurance: Proposition 36 is payer agnostic and not all those who meet criteria for the treatment-mandated felony will qualify for Medi-Cal County behavioral health services. County behavioral health agencies do not have the infrastructure nor funding to serve additional populations within the county behavioral health delivery system. The Legislature should leverage existing commercial insurance requirements for behavioral health care (SB 855, Wiener, 2020) and further clarify that commercial insurance is required to cover treatment provided under Proposition 36, similar to the language included in the CARE Act (SB 1338, Umberg, 2022), will ensure that county behavioral health agencies and providers are reimbursed for the services provided to individuals who may not meet Medi-Cal eligibility criteria.
Implement Robust Spending and Outcomes Reporting: To ensure that Proposition 36 achieves its intended goals, all new funds should be accompanied by clear spending and outcomes reporting requirements. Transparency and accountability measures should not duplicate existing reporting, outcomes, and accountability requirements and leverage existing reporting mechanisms to the extent possible in order to reduce the documentation burden on providers and plans. Requiring reporting will help track the success of the various investments made by the state, identify areas for improvement, and demonstrate the positive impact of investing in behavioral health services.
These recommendations can help ensure that individuals charged with treatment-mandated felonies receive the care they need. However, there is also a need to build out our substance use treatment system beyond these recommendations to ensure Californians get care before they are involved in the justice system. We would urge the Legislature to continue to invest in substance use treatment and support services. Our coalition stands ready to collaborate with the Legislature and the Administration to advance these vital improvements. Should you have any questions, please feel free to contact Tara Gamboa-Eastman with the Steinberg Institute at tara@steinberginstitute.org.
Sincerely,
Karen Larsen Chief Executive Officer Steinberg Institute
Le Ondra Clark Harvey Chief Executive Officer California Behavioral Health Association
Robb Layne Executive Director California Association of Alcohol and Drug Program Executives
Pete Nielsen President and Chief Executive Officer California Consortium of Addiction Programs and Professionals
Michelle Doty Cabrera Executive Director County Behavioral Health Directors Association
Heid Strunk President and CEO Mental Health America of California
Anne Irwin Founder and Director Smart Justice
Anthony Di Martino Government Affairs Director Californians for Safety and Justice
Grey Gardiner State Director, California Drug Policy Alliance
Claire Simonich Associate Director Vera Institute for Justice
Paul Yoder Legislative Advocate California State Association of Psychiatrists
Selena Liu Raphael Senior Policy Advocate California Alliance of Child and Family Services
Chad Costello Executive Director California Association of Social Rehabilitation Agencies
Tyler Rinde Director of Government Affairs California Psychological Association
Meron Agonafer Policy Director CalVoices
CC: Senator Akilah Weber, Senate Subcommittee No. 1 Chair Assemblymember Dawn Addis, Assembly Subcommittee No. 1 Chair Scott Ogus, Senate Budget Deputy Staff Director Nora Brackbill, Senate Budget Subcommittee No. 5 Consultant Jennifer Kim, Assembly Budget Subcommittee No. 6 Consultant Patrick Le, Assembly Budget Subcommittee No. 1 Consultant Eric Dang, Principal Consultant, Office of President Pro Tempore Mike McGuire Marjorie Swartz, Principal Consultant, Office of President Pro Tempore Mike McGuire Shaun Naidu, Policy Consultant, Office of Speaker Robert Rivas Rosielyn Pulmano, Policy Consultant, Office of Speaker Robert Rivas
1 This estimate was determined by estimating the annual number of treatment-mandated felonies to be 13,164 people per year based on the data from the Judicial Council Proposition 36 Survey. This estimate assumes that treatment costs will be $20,000 per person on average and that 80% percent of those charged with treatment mandated felonies will be Medi-Cal eligible and, therefore, 50% of the costs will be covered by the federal government. The formula used was (13,164)*(0.8)*(0.5)*($20,000) = $105,312,000.3
The Honorable Mia Bonta Chair, Assembly Health Committee 1020 N Street, Room 390 Sacramento, CA 95814
RE: Support for AB 539 (Schiavo)
Dear Chair Bonta,
Mental Health America of California (MHAC) is pleased to support Assembly Bill 539 (Schiavo), legislation that would allow prior authorizations for health care services to remain valid for one year from the date of approval.
MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. Prior authorization procedures can create significant barriers to accessing voluntary mental health and substance use services.
The prior authorization process requires providers to obtain approval from health plans before delivering certain services or support, including mental healthcare. However, it can take anywhere from one to five days before receiving approval. Additionally, prior authorizations are not permanent. How long an authorization remains active is determined by and varies across health plans and may need to be renewed multiple times for the same care within a given year. These delays create unnecessary barriers to addressing known health challenges and will widen the gap in access to vital support and services intended to help individuals before they reach a point of crisis.
This bill helps ensure continuity of care by reducing disruptions caused by repeated prior authorization requests by standardizing the length of approval for at least one year. It is for these reasons MHAC supports AB 539 (Schiavo) and asks for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any behavioral health legislation, please do not hesitate to contact me at hstrunk@mhac.org or our Director of Public Policy, Karen Vicari, at kvicari@mhaofca.org.
