SUBJECT
Title
RECEIVE UPDATE ON ENHANCING BEHAVIORAL HEALTH ACCESSIBILITY; AUTHORIZE MULTIPLE REQUESTS FOR STATEMENT OF QUALIFICATIONS TO ESTABLISH CONTRACTS FOR CRITICAL SERVICES; AND ADOPT THE REVISED LANTERMAN-PETRIS-SHORT DESIGNATION GUIDELINES AND PROCESSES FOR FACILITIES WITHIN SAN DIEGO COUNTY (DISTRICTS: ALL)
Body
OVERVIEW
In California, counties are responsible for administering specialty mental health and substance use services for residents eligible for Medi-Cal. The County of San Diego (County) Behavioral Health Services (BHS) department serves as the Specialty Mental Health Plan and Drug Medi-Cal Organized Delivery System. To ensure access to quality care that meets the needs of Medi-Cal beneficiaries in San Diego County, BHS is required to maintain a local network of behavioral health services and providers. The San Diego County Board of Supervisors (Board) has made key investments over the last several years to enhance community-based behavioral health services and develop critical behavioral health infrastructure that is regionally distributed in alignment with population health needs.
In 2022, BHS developed the Behavioral Health Optimal Care Pathways (OCP) model outlining the existing and optimal future capacity necessary across community crisis diversion services, community-based care, and subacute care based on data and lengths of stay more optimal for patient care. The OCP model emphasizes a behavioral health system that prioritizes care for adults that meets their individual needs in the least restrictive settings. Since developing the OCP model, BHS has taken multiple actions to build dedicated service capacity within community crisis diversion, subacute care, and community-based care, along with working to improve access to substance use and inpatient care. The County continues pursuing partnerships across the region that will enhance the continuum of care.
On January 28, 2025 (19), the Board authorized multiple actions to improve access to behavioral health care locally that will be achieved by enhancing existing partnerships or through new partnerships and directed a return to the Board within 90 days with updates on actions related to specific recommendations, to seek contracting authority, and to establish appropriations, if needed. Today’s item requests the Board to receive the 90-day update and seeks authority for multiple contracting actions to advance critical services that will improve behavioral health services across the continuum of care. Also included is an update on workforce development opportunities through the expansion of academic clinical training programs.
As efforts to improve access to substance use and inpatient care continue, quality standards and program guidelines are concurrently revised to ensure compliance with updated regulations and requirements. As a result, today’s item also includes a request to adopt revisions to the County Lanterman-Petris-Short (LPS) Designation Guidelines and Processes for Facilities within San Diego County. These guidelines update criteria for evaluation and treatment services and facilities eligible for LPS designation, include additional data collection requirements, and clarify advisement and documentation guidelines to align with California Senate Bill 43 legislative changes and resulting operational updates.
These actions support the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished through further strengthening the continuum of behavioral health services by expanding care in San Diego County and updating the guidelines that support these critical services.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Receive update about enhancing behavioral health accessibility.
2. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue a Request for Statement of Qualifications (RFSQ) for partial hospitalization and intensive outpatient programs for people with behavioral health conditions, and re-release the RFSQ, as needed, and upon successful negotiations and determination of a fair and reasonable price, award contracts for up to 35 slots for an Initial Term of up to one year, with up to four 1-year Options, and an additional six months, if needed, and to amend the contracts, as needed, to reflect changes in program, funding or service requirements, subject to the availability of funds and approval of the Chief Administrative Officer, or designee.
3. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue a Request for Statement of Qualifications (RFSQ) for chemical dependency recovery hospital beds for people with substance use conditions, and re-release the RFSQ, as needed, and upon successful negotiations and determination of a fair and reasonable price, award contracts for up to 22 beds for an Initial Term of up to one year, with up to four 1-year Options, and an additional six months, if needed, and to amend the contracts, as needed, to reflect changes in program, funding or service requirements, subject to the availability of funds and approval of the Chief Administrative Officer, or designee.
4. Adopt the revised Lanterman-Petris-Short Designation Guidelines and Processes for Facilities within San Diego County.
EQUITY IMPACT STATEMENT
The County of San Diego (County) Behavioral Health Services (BHS) is the service delivery system for Medi-Cal eligible residents with substance use care needs. In 2024, nearly one in three residents were eligible for Medi-Cal, with Hispanic and Latino residents having the highest percentage of Medi-Cal eligibility at 44%.
For Medi-Cal eligible residents who experience serious mental illnesses or have a substance use care need, BHS offers County-operated and contracted programs that prioritize addressing the social determinants of health. The goal is to ensure services are accessible, capable of meeting the needs of diverse populations, culturally responsive, and equitably distributed to providing care to those most in need. In doing so, BHS strives to reduce behavioral health inequities, identifying needs and designing services in a manner most impactful and equitable that will yield meaningful outcomes for those served. A comprehensive array of behavioral health services is vital for BHS to continue providing access to treatment and care for populations who are underserved by social and behavioral health resources.
SUSTAINABILITY IMPACT STATEMENT
Today’s actions support the County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to County services and Sustainability Goal #4 to protect the health and well-being of everyone in the region. These goals will be accomplished by providing a wider availability and range of supportive, inclusive, and stigma-free options to those in need of behavioral health services. Access to a comprehensive continuum of behavioral health services will improve the overall health of communities.
FISCAL IMPACT
Funds for these requests are included in the Fiscal Years (FY) 2025-26 CAO Recommended Operational Plan in the Health and Human Services Agency (HHSA). If approved, today’s recommendations will result in approximate costs and revenue of $15.1 million in FY 2025-26. The funding sources are Short-Doyle Medi-Cal, Drug Medi-Cal, Realignment, and one-time General Purpose Revenue allocated by the San Diego County Board of Supervisors on February 27, 2024 (11) for the implementation of California Senate Bill 43.
Impending federal policy changes that are being proposed may have significant impacts on the financial sustainability of local mental health and substance use treatment programs funded through Medicaid, or Medi-Cal in California. Any significant Medicaid policy changes will impact the County of San Diego’s ability to financially sustain behavioral health Medi-Cal programs. Additionally, growth in Realignment funding has not kept pace with the increased costs for services, which is utilized as a local match for Medi-Cal programs.
At this time, there will be no change in net General Fund cost and no additional staff years. HHSA will continue to monitor any federal policy changes and will return to the Board as needed to address any significant impact as policies are implemented.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
Information on this item was shared with the Behavioral Health Advisory Board at their regular meeting on March 6, 2025.
BACKGROUND
In California, counties are responsible for administering specialty mental health and substance use services for residents eligible for Medi-Cal. The County of San Diego (County) Behavioral Health Services (BHS) serves as the Specialty Mental Health Plan and Drug Medi-Cal Organized Delivery System. To ensure access to quality care that meets the needs of Medi-Cal beneficiaries in San Diego County, BHS is required to maintain a local network of behavioral health services and providers. The San Diego County Board of Supervisors (Board) has made key investments over the last several years to enhance community-based behavioral health services and develop critical behavioral health infrastructure that is regionally distributed in alignment with population health needs.
Locally, there is an urgent need to improve access to behavioral health care for Medi-Cal beneficiaries who face significant barriers to behavioral health treatment. Bottlenecks within the system and limited capacity result in a lack of timely access to care. People facing barriers to access may experience prolonged and untreated mental illness or substance use conditions, resulting in increased acuity, and unnecessary or prolonged institutionalization or hospitalization. They also face challenges to recovery if they remain in higher levels of care because they are unable to step down to a lower level of care aligned with their needs. These challenges result in increased costs to the regional healthcare systems and lack of available beds for people experiencing a behavioral health crisis.
In 2022, BHS developed the Behavioral Health Optimal Care Pathways (OCP) model outlining the existing and optimal future capacity necessary across community crisis diversion services, community-based care, and subacute care based on data and lengths of stay more optimal for patient care. The OCP model emphasizes a behavioral health system that prioritizes care for adults that meets their individual needs in the least restrictive settings. Since developing the OCP model, BHS has taken multiple actions to build dedicated service capacity within community crisis diversion, subacute care, and community-based care, along with working to improve access to substance use and inpatient care. The County continues pursuing partnerships across the region that will enhance the continuum of care.
On January 28, 2025 (19), the Board authorized multiple actions to improve access to behavioral health care locally that will be achieved by enhancing existing partnerships or through new partnerships and directed a return to the Board within 90 days with updates on the following actions, and to seek contracting authority, and to establish appropriations, if needed:
• Enter into discussions with Prime Healthcare to expand the number of behavioral health psychiatric acute inpatient beds available to people who are Medi-Cal eligible within Paradise Valley Hospital.
• Explore partnerships and funding strategies to enhance Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP) services.
• Explore partnerships and funding strategies to enhance substance use disorder treatment services.
• Explore partnerships and funding strategies to enhance regional Board and Care capacity.
• Explore opportunities to enhance partnerships between these programs and local academic institutions.
Federal Policy Changes Impacting Medicaid
Impending federal policy changes that are being proposed will likely have significant impacts on the financial sustainability of local mental health and substance use treatment programs funded through Medicaid, or Medi-Cal in California. BHS Medi-Cal programs receive a high rate of federal reimbursement. In the current fiscal year, BHS budgeted nearly $390 million of Medi-Cal funding to support behavioral health treatment services locally and next fiscal year Medi-Cal revenue is anticipated to increase through the new Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) waiver. On March 11, 2025 (15), the Board authorized BHS to opt in to the BH-CONNECT waiver; however, potential policy changes at the federal level could directly impact BHS’ ability to expand and financially sustain Medi-Cal programs, with initial proposals resulting in significant potential federal revenue losses across BHS mental health and substance use programs.
Though the extent of the impact resulting from new federal policies is still unknown, changes to Medicaid will likely affect the County’s ability to sustain local substance use and mental health treatment programs and will impact other non-Medi-Cal programs if there is a need to backfill federal funding. Therefore, moving forward with the recommended actions for additional behavioral health service capacity, if approved, will be dependent on the availability of sustainable Medi-Cal funding.
Psychiatric Acute Inpatient Care
On January 28, 2025 (19) the Board directed the Chief Administrative Officer (CAO) to enter into discussions with Prime Healthcare to expand the number of behavioral health psychiatric acute inpatient beds available to people who are Medi-Cal eligible within Paradise Valley Hospital located in the South Region. Paradise Valley Hospital provides psychiatric inpatient hospital services to eligible adults and older adults who experience a psychiatric emergency and require acute inpatient services to stabilize and ensure their safety and the safety of others. Services are provided in a secure environment where people can stabilize and establish an aftercare plan prior to discharge. Psychiatric acute inpatient care is the highest level of care acuity within the behavioral health continuum of care and County contracted beds within these facilities are not dedicated to only County Medi-Cal patients.
The County currently contracts up to 39 acute inpatient beds with Paradise Valley Hospital, inclusive of services for forensic clients. Negotiations are underway between the County and Prime Healthcare to amend the Paradise Valley Hospital contract to add up to 30 new contracted psychiatric acute inpatient beds to serve people with Medi-Cal. Services are billable and able to draw down a significant amount of Medi-Cal funding.
Partial Hospitalization and Intensive Outpatient Programs
In the same action on January 28, 2025 (19), the Board directed the Chief Administrative Officer (CAO) to explore partnerships and funding strategies to establish partial hospitalization program (PHP) and intensive outpatient program (IOP) services for children and adults. PHP and IOP services are outpatient services. Currently, PHP and IOP services for adults with serious mental illness (SMI) who are Medi-Cal beneficiaries are not currently available within County-funded behavioral health programming. BHS has one PHP and IOP program for children that began in March and January 2024, respectively, each of which provides 12 slots that are not exclusively available to BHS-funded clients.
A PHP provides structured outpatient treatment services for those who need a higher level of care for SMI or SED; it provides outpatient psychiatric services as an alternative to inpatient psychiatric care and is more intense than outpatient care. Moreover, it provides people with comprehensive mental health services, including individual and group therapy and medication management, while allowing them to return home at night. Patients can receive treatment during the day and do not need to stay overnight. Patients attend therapy sessions in person within a recovery facility, thereby allowing patients to access care without disconnecting from their daily routines. An IOP provides treatment, including in-person visits, case management, medication management, group therapy, and a personal treatment plan developed by mental health professionals. An IOP is a level of care between outpatient care and more intensive residential treatment or inpatient care and is designed to help people develop coping mechanisms needed to manage their own care at home.
PHPs and IOPs are evidence-based services utilized by various behavioral health systems across the country and locally within other health plans. These services offer a bridge between inpatient care and traditional outpatient therapy and have been shown to improve long-term behavioral health outcomes and reduce readmission rates for people who were previously hospitalized with a behavioral health condition. Expanding these services to Medi-Cal eligible adults and increasing capacity for children will enhance access to care for people with SMI and SED. If approved, today’s action will authorize a Request for Statement of Qualifications (RFSQ) to contract for up to 35 new PHP/IOP slots for children and adults who are Medi-Cal eligible, based on the availability of Medi-Cal and local funding.
Substance Use Treatment Services
The January 28, 2025 (19) Board action also directed the CAO to explore partnerships and funding strategies to enhance substance use treatment services. BHS has taken actions over the last several years to enhance capacity across substance use treatment services, including the expansion of opioid treatment program slots, residential treatment slots, and outpatient services. This includes enhancing rates through the implementation of Behavioral Health Payment Reform to support more equitable reimbursement for substance use programs.
Additionally, on March 4, 2025 (1), BHS introduced the Substance Use Disorder Optimal Care Pathways (SUD OCP) model to the Board, which aims to improve capacity within the substance use system of care to effectively connect, engage, and support a growing population of clients throughout their recovery journey. Using both local and national data, the SUD OCP model estimates the number of clients served and the services they would require in a system that is designed to optimize treatment engagement. It also incorporates estimates of the demand for services upon implementing foundational changes in how we reach individuals in crisis, breaking the cycle to prevent future hospitalizations, justice involvement, and mortality risk. The SUD OCP model responds to the unique challenges of substance use in a manner that is client-centered, community-based, and grounded in proven evidence-based practices. The major changes under an optimally designed SUD OCP model would significantly impact capacity needs in the following four key areas:
• Transitional support, which provides short-term care for adults who do not need to be in the hospital but need additional supports to recover.
• Residential care, which provides round the clock clinical treatment.
• Outpatient care, which offers community-based treatment and recovery support services.
• Housing resources, which include shared housing for adults currently receiving treatment.
Though not inclusive of all substance use care options, expanding these services will be the most impactful in helping people get connected and stay connected to care throughout their lives.
BHS has continued making strides in expanding access to care for people with substance use conditions, including establishing the first partnership locally in 2023, with a Tribal 638 clinic, Revive Pathway, an entity wholly owned by the Viejas Band of Kumeyaay Indians. The program was initially contracted to provide 150 opioid treatment program (OTP) slots and recently expanded to 200 slots. Discussions are underway to add another 50 slots, for a total of 250 OTP slots at the clinic in the city of El Cajon. Revive Pathway fully funds the non-federal share of cost (the match) for Medicaid and Medicare reimbursement for OTP services; therefore, there is no financial impact to the County for the existing OTP slots or the additional OTP slots that will be added. In addition, BHS has implemented ambulatory withdrawal management (AWM) services, which are clinical-based programs that help people safely stop using drugs or alcohol by monitoring and treating symptoms associated with reducing or stopping substance use. Further expansion of AWM is planned, and to date the program has provided AWM services to more than 420 individuals.
BHS launched San Diego Relay in October 2024, a peer response system in selected emergency departments for individuals with a nonfatal overdose and/or an involuntary behavioral health hold. Peers are deployed to meet with patients at emergency departments to assess needs, offer peer navigation, and facilitate linkage to SUD treatment, harm reduction services, and other services. Peers offer navigation and support for a period of 90 days after patients are discharged from an emergency department. As of February 2025, two sites, Scripps Mercy Hospital San Diego and Scripps Mercy Hospital Chula Vista, are operational with planning underway for implementation at one additional site within the city of San Diego.
To further build capacity within the substance use system, on October 8, 2024 (5) the Board approved a competitive procurement for 49 new recuperative care beds, which will include 16 beds within the County-owned Substance Use Residential and Treatment Services (SURTS) facility and 33 beds within the community expected to be operational in mid-2025. Renovations to the SURTS facility are underway and are anticipated to be completed in mid-2026. Also anticipated within the SURTS facility will be approximately 73 new substance use residential treatment beds. Staff will return to the Board at a future date to seek procurement authority for these beds.
BHS is also working with local hospitals to identify capacity for chemical dependency recovery hospital (CDRH) beds, a service that does not currently exist within our continuum of care. CDRHs provide 24-hour inpatient care for people with alcohol and/or substance use dependency, and include services such as counseling, group therapy, physical conditioning, family therapy, outpatient services, and dietetic services. If approved, today’s action will authorize an RFSQ for up to 22 new CDRH beds for adults who are Medi-Cal eligible, subject to the availability of Medi-Cal and local funding.
In addition to introducing new programs to ensure readiness for California Senate Bill (SB) 43, the County must update local Lanterman-Petris-Short (LPS) Designation Guidelines and Processes For Facilities Within San Diego County (Attachment A) for LPS facilities to align with the new statute. SB 43 makes changes to the LPS Act, a California law governing involuntary detention, treatment, and conservatorship of people with behavioral health conditions. The LPS Act provides a procedure for the involuntary detention for evaluation and treatment of persons who constitute a danger to themselves or others or are gravely disabled. The LPS Act also requires that persons detained be placed in facilities designated for involuntary detention by a county’s board of supervisors. The Board or designee can designate facilities that meet State requirements to evaluate and treat persons involuntarily detained under the LPS Act. BHS utilizes approved LPS Designation Guidelines and Processes for Facilities Within San Diego County that outline criteria and process requirements for facility designation. Once a facility has been locally designated, the County relays the recommendation to the California Department of Health Care Services (DHCS) for approval and facility list management.
SB 43 expands the definition of “gravely disabled” to include people with a severe substance use disorder, or a co-occurring mental health disorder and a severe SUD, and who are unable to provide for their basic needs for food, clothing, shelter, access to necessary medical care, or personal safety. BHS worked with several contracted service providers to enhance substance use treatment services within inpatient and crisis stabilization unit settings to support people with meeting SB 43 criteria, which began on January 1, 2025.
Today’s action requests approval to adopt revisions to the LPS Designation Guidelines and Processes within San Diego County, which update criteria for evaluation and treatment services in alignment with SB 43 legislative expansion of “gravely disabled” definition and includes community programs as eligible for designation when all applicable regulations are met. Revisions include additional data collection requirements implemented through legislative and State actions and require enhanced reporting from designated facilities. LPS designated providers have been informed and are in the process of implementing the new requirements. The Board last approved revisions to the LPS Designation Guidelines and Processes for Facilities Within San Diego County on September 10, 2019 (9). The updated guidelines are included as an attachment to this letter.
Licensed Board and Care Slots
The Board also directed the CAO to explore partnerships and funding strategies to make progress toward increasing licensed board and care capacity for people with SMI by approximately 400 beds, as outlined in the OCP model to meet regional behavioral health service needs. Licensed board and care facilities include adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs) that provide housing and 24-hour support for people in need of care who are unable to live independently in other types of housing. BHS continues to make significant progress in establishing new board and care capacity through grant funding awarded by the State, including the BHBH grant and the Community Care Expansion Preservation (CCE-Preservation) grant.
On July 18, 2023 (15), the Board authorized the acceptance of $44.3 million of BHBH round 1 grant funds from DHCS to increase bridge housing capacity for people with serious behavioral health conditions who are experiencing homelessness. These grant funds are available through June 30, 2027.
• In March 2024, BHS amended two existing contracts to add 55 new board and care slots using BHBH grant funds.
• In February 2025, BHS awarded additional BHBH grant funds through amendments to existing contracts and to four new licensed board and care providers through an RFSQ for an additional 166 board and care slots, inclusive of 34 enhanced slots for people with complex needs.
• This brings the total number of licensed board and care slots to 475, a 97% increase from the 241 slots that were operational at the time of the OCP model implementation in 2022.
BHS will issue an additional RFSQ for remaining BHBH grant funds to ensure funding is maximized for new board and care slots. Additionally, it is anticipated that once the Behavioral Health Services Act goes into effect on July 1, 2026, there will be additional financial opportunities to sustain and enhance licensed board and care slots.
On June 28, 2022 (4) the Board authorized the acceptance of $12.5 million of one-time CCE-Preservation funding from DHCS to support the preservation of licensed residential adult and senior care facilities. The CCE-Preservation grant funds were designated for existing licensed board and care facilities, inclusive of ARFs and RCFEs, to subsidize the physical repairs necessary to maintain compliance with licensing and for current or potential operating deficits to avoid closure of these facilities, which have historically struggled with being financially sustainable.
On January 24, 2023 (9), the Board accepted an additional $3.4 million of CCE-Preservation, bringing the total CCE-Preservation grant funds to nearly $16.6 million. Approximately $9.5 million of total funding is designated for capital costs and $7.1 million for operating subsidy payments. The County is also required to provide a 10 percent match of approximately $1.0 million. The capital project funding is available through December 31, 2026, and the operating subsidy payment funding is available through June 30, 2029.
In May 2024, a Notice of Funding Award was issued, and subsequent orientation was facilitated to provide information to potential applicants. All 10 applications that requested funds received funding awards. BHS worked with the State’s technical assistance provider and an as-needed construction consultant to develop a process for assessing applicants’ requests for capital projects to ensure alignment with the CCE-Preservation requirements, including prevailing wage. Because all the projects were relatively small in nature, a single prevailing wage contractor was secured to complete the capital projects across all 10 facilities to support efficiency across work and reporting, cost containment, and timely completion of projects. The grant funding has been awarded to 10 licensed board and care facilities, inclusive of 8 ARFs and 2 RCFEs. It is expected the grant funds will preserve licensed board and care beds for 440 residents.
To further establish dedicated community-based care capacity, BHS has been working in partnership with the County Department of General Services (DGS) to explore opportunities with developers/operators to develop, construct, and operate the Central Region Community-Based Care (CBC) facility located on County-owned property in Hillcrest. The Central Region CBC would establish approximately 110 new board and care slots and more than 10 recuperative care beds to support people with complex behavioral health needs who are Medi-Cal beneficiaries. With the support of a contracted consultant, BHS and DGS staff are participating in formal interviews with potential developer/operators to better understand the different opportunities available to finance, develop, construct, operate, fund, and maintain the CBC. This process will allow the County to assess the best organization with the necessary experience and expertise required to operate the Central Region CBC to ensure the delivery of high-quality behavioral health care and financial sustainability. BHS will report back to the Board in July 2025 with additional updates and actions recommended for this project.
Partnerships with Local Academic Institutions
Lastly, the January 28, 2025 (19) Board action directed the Chief Administrative Officer to explore opportunities to enhance partnerships between service providers and local academic institutions. There are two streams of work that will occur under the umbrella for academic institutions, which include 1) education and training opportunities to grow the public behavioral health workforce, and 2) innovative clinical models and research modes to ensure that Medi-Cal enrolled residents have access to the best care.
The expansion of the services further highlights the need to grow and retain a competent, skilled local behavioral health workforce by partnering with regional academic institutions and healthcare providers to establish academic clinical training programs. Enhancing clinical training opportunities will enhance workforce development by creating opportunities for people to pursue behavioral health careers in psychiatry, nursing, social work and other behavioral health therapeutic training, pharmacy, and other healthcare careers to improve the quality of care delivered by behavioral health programs locally. This will build on and broaden efforts of the Live Well Center for Innovation and Leadership, a partnership between the County Health and Human Services Agency and San Diego State University, to develop a skilled and resilient workforce.
Based on recommendations outlined in the 2022 Behavioral Health Workforce Report, BHS developed the Public Behavioral Health Workforce Development and Retention program to grow workforce capacity across various types of jobs. The program, which was approved by the Board on May 2, 2023 (5), authorized $75 million of Mental Health Services Act Innovation funds over five years to attract and retain workers in the public behavioral health field through training, tuition support, upskilling, and incentive opportunities. The program will be called the ELEVATE Behavioral Health Workforce Fund (ELEVATE Fund). The ELEVATE Fund will be available to people locally who are currently working or interested in working in County-funded behavioral health programs, and will include no cost trainings, zero percent interest loans and student-friendly financing options for higher education, and grants for training and clinical supervision. Repayments received through the loan program will be recycled to serve additional individuals in the future. It will also require partnership with local universities and community colleges for students receiving support from the workforce program.
Program planning for the ELEVATE Fund has been underway since October 2024, in partnership with the program administrator, with informational sessions being held in March and April of this year. The first enrollments are anticipated to begin in Fall 2025, in alignment with the new school year, and the ELEVATE Fund is anticipated to serve approximately 2,800 people over five years.
Workforce development opportunities will also become available through the BH-CONNECT Workforce Initiative, which aims to support training and retention of people who provide services to Medi-Cal members living with significant behavioral health needs. The BH-CONNECT Workforce Initiative will provide funding opportunities to expand the behavioral health workforce through scholarships, loan repayment, recruitment and retention incentives, community-based provider training programs for paraprofessionals, and residency training programs. The BH-CONNECT Workforce Initiative will provide $1.9 billion statewide and will be managed through the Department of Health Care Access and Information. Pending the release of guidance, BHS will build on the opportunities available through the Workforce Innovation program.
Partnering with academic institutions will also be critical in developing training capacity, and innovative service modeling and research opportunities within our provider network. For example, the expertise within local academic institutions in multi-disciplinary treatment team modeling and integrated care, along with interventional psychiatry, are innovative clinical approaches to which Medi-Cal enrollees have historically not had access. Scaling of these services for Medi-Cal enrollees and further developing them through clinical research will be prioritized emphases through our academic partnerships.
Today’s actions request the Board receive an update on opportunities to improve the accessibility to care across the behavioral health continuum of care; authorize contracting activities; and adopt the revised LPS Guidelines to support quality and compliance with regulations and operations.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego 2025-2030 Strategic Plan initiatives of Equity (Health) and Community (Quality of Life) as well as the regional Live Well San Diego vision, by implementing new services that are designed to improve outcomes for people with mental illness and substance use disorders and ensuring access to a comprehensive continuum of behavioral health services administered through accessible behavioral health programs.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
Attachment A - Lanterman-Petris-Short (LPS) Designation Guidelines and Processes for
Facilities Within San Diego County