About Behavioral Health
An estimated 7.5 million people in California experience a mental health disorder in any given year, but only one-third of adults who experience mental illness are getting treatment. The caregivers at hospitals know the obstacles people with behavioral health conditions face and the challenges in getting them the treatment they need.
While hospitals embrace the essential role they play in addressing this crisis, more needs to be done. Investments are needed to tackle a crisis made even worse by COVID-19. California must prioritize behavioral health investments in prevention, early assessment, identification of needs, and aggressive treatment for all, regardless of health coverage or ZIP code.
In addition, solutions like payment reform, resource allocation, more outpatient and community-based services, a bolstered behavioral health workforce, and a statewide set of standardized core services will help Californians with behavioral health conditions access the care they deserve.
This point-in-time analysis was conducted in 2017-2018 to gain a deeper understanding of the behavioral health challenges faced by San Diego patients. Issues examined included pre-acute, acute, and post-acute services and the impact of social determinants of health on access and outcomes. Ultimately, the findings are intended to support further research efforts and to promote collaboration between San Diego County Behavioral Health Services and other community organizations providing behavioral health services in San Diego.
CALAIM INCENTIVE PAYMENT PLAN PROGRAM UPDATE: The California Advancing and Innovating Medi-Cal (CalAIM) Incentive Payment Program is intended to support the implementation and expansion of enhanced care management and community supports by incentivizing managed care plans (MCPs) to drive MCP delivery system investment in provider capacity and delivery system infrastructure. It is also intended to bridge current silos across physical and behavioral health care service delivery; reduce health disparities and promote health equity; achieve improvements in quality performance; and encourage take-up of community supports. More information on the MCP Incentive Payment Plan Program Year 1 Gap Filling Plan is available by county (San Diego and Imperial included) on the Department of Health Care Services website. Additional general information on the Incentive Payment Program can be found on the CalAIM Roundtables by Region web pages for San Diego and Imperial counties.
HEALTH SERVICES CAPACITY TASK FORCE: The All-Hazard Health Services Capacity Management Plan activation level has been elevated from Level 3 Partial Activation to Level 2 Escalated Activation. Over the last week, system metrics have suggested increasing stresses on health care capacity. These indicators include increased emergency department boarders, larger emergency medical services system volumes, and rising wastewater viral detections. Close system monitoring is ongoing to determine the need to escalate to a higher plan level and various mitigation tools may be activated if necessary. Maintaining masking, physical distancing, and other protective practices are vital to minimizing the level of the current patient surge, and vaccinations and boosters against COVID-19 and influenza are strongly encouraged. The Health Services Capacity Task Force Operational Group continues to meet regularly, and sector representatives will provide important updates, facilitate information sharing, and recommend coordinated plan actions to optimize health care delivery countywide.
SAN DIEGO COUNTY BOARD OF SUPERVISORS: On June 28, the County of San Diego Board of Supervisors unanimously adopted a $7.36 billion budget for the 2022-23 fiscal year, with significant investments in behavioral health, homelessness, equity, racial justice, and climate change. Additionally, the board unanimously declared fentanyl as a public health crisis, which will direct county staff to develop a comprehensive strategy to address this crisis and devote more resources to fentanyl education, treatment, recovery, and harm reduction strategies. Board Chair Nathan Fletcher also indicated the county is expected to receive $100 million from a lawsuit settlement with opioid manufacturers, and funding could be directed toward the effort. From August to October, the county will host workshops to get feedback from the community on how to prioritize settlement dollars, and the board will meet in October to consider a framework. Lastly, the board unanimously approved all recommendations and actions to enhance human trafficking prevention and service coordination efforts to support survivors. With this action, the county also authorized procurement to establish peer support navigation services for adult survivors
EMSA AND CDPH WAIVERS: CHA is seeking the extension of the California Department of Public Health (CDPH) and Emergency Medical Services Authority (EMSA) COVID-19 waivers from June 30 to Sept. 30. With a projected summer wave of COVID-19 threatening to strain an already stressed health care delivery system, these flexibilities are critical to maintaining the current health care capacity in California. Specifically, the waivers at risk are:
Both waivers will need an executive order to be issued by the governor’s office to update the most recent executive order’s provisions that otherwise will expire. CHA is advocating for these executive order provisions, and corresponding CDPH and EMSA waivers, to be renewed as soon as possible. CHA has developed talking points that hospitals may want to use in outreach to state legislators and department officials about the impacts to their communities if these flexibilities are not extended. HASD&IC submitted feedback from members to help with CHA’s advocacy efforts.
MEDI-CAL ELIGIBILITY FOR NEW UKRAINIAN ARRIVALS: The Department of Health Care Services (DHCS) has released a Medi-Cal Eligibility Division Information Letter to provide guidance to counties on the Medi-Cal eligibility of Ukrainian nationals arriving in California. It is anticipated that a significant number will resettle in California. The federal government has not provided any special benefit eligibility for this population, but has authorized the use of Temporary Protected Status (TPS) for Ukrainian arrivals who qualify. Many of the Ukrainian arrivals may enter under TPS or as humanitarian parolees and may not be eligible for the traditional federal services offered to immigrants granted refugee status. However, they may qualify for state-funded programs, including state-funded full-scope Medi-Cal. The letter provides guidance on how to establish Medi-Cal eligibility for this population (based on current Medi-Cal policy) for state and federal Medi-Cal benefits. DHCS will work closely with the state Office of Refugee Health and stakeholders to ensure that new Ukrainian arrivals receive the Medi-Cal benefits to which they are entitled.
IMPERIAL VALLEY HOMELESSNESS: At the April 12 Imperial County Board of Supervisors meeting, the Imperial Valley Continuum of Care Council Administrative Entity provided details of how they are addressing homelessness and overall accomplishments so far. Updates include a redesign of an operating Coordinated Entry System, the entity’s pandemic response (a region-wide survey to understand needs), update on current continuum of care programs, and projects such as the new Homeless Day Center that will provide services to over 700 individuals per year, Lotus Living Community (transitional housing) for Imperial Valley College students, and youth programs for those experiencing homelessness that have served 156 youth.
MONOCLONAL ANTIBODIES: The California Department of Public Health (CDPH) has issued a COVID-19 Therapeutics Needs Assessment survey to understand how frequently antiviral medications and monoclonal antibody treatments are being used in each jurisdiction and/or health care facility. The survey is designed to help CDPH understand challenges and successes in outpatient treatment of COVID-19. As the landscape of outpatient therapeutics is changing rapidly, there have been several versions of this survey. Hospitals are encouraged to complete the survey even if another version was previously completed. More information on COVID-19 therapeutics options is available on the CDPH COVID-19 treatments page.
DONATION OF MEDICAL SUPPLIES FOR UKRAINE: The Naval Medical Center’s Zachary Alexander, MD, is working with the House of Ukraine, a local organization, to help obtain donations of medical supplies to send to Ukraine for humanitarian aid. The organization has established two flights per week from Los Angeles to Ukraine, and they are seeking all kinds of medical supplies, including expired and near-expired materials. A priority list of critically needed supplies is available; contact Dr. Alexander at Zac.email@example.com or (240) 426-3708 for more information about donating.