Board asks CAO to request state funding for SB 43 implementation as county readies treatment capacity

The San Diego County Board of Supervisors voted Sept. 24 to ask the county chief administrative officer to send a letter to the governor requesting the resources the county says are needed to implement Senate Bill 43.

Supervisor Jim Desmond, who brought the item, said SB 43 “broadens the criteria for eligibility to be placed under conservatorship” to include people gravely disabled by substance use disorder and that implementing the law will likely increase the number of initial holds and demand for treatment space.

Nut graf: The board approved a request that the county seek state funding and clarity on reimbursement to build and modify treatment and acute‑care capacity required under SB 43; county behavioral health staff described the estimates as high‑level and anchored to projected hold volumes but said the county needs additional funding and regulatory guidance to implement the law effectively.

County behavioral health leaders told the board the readiness estimates are high level and intended to cover new acute‑care and co‑occurring treatment capacity linked to SB 43. Dr. Nicole Esposito, co‑chair of the county’s SB 43 readiness committee, and Dr. Luke Bergman, director of Behavioral Health Services, explained the estimates reflect current gaps in reimbursable infrastructure and anticipated volumes of new holds related to substance use disorder. Esposito said the estimates look “high” in part because the county lacks efficient reimbursement pathways for the co‑occurring population and because regulated clinical space for some populations does not currently exist.

The board’s action directs the chief administrative officer to send a letter to the governor requesting the resources necessary to initiate SB 43 implementation and to maintain the program. The motion was introduced by Supervisor Desmond; a second was recorded and the motion passed unanimously.

Public comment split between those who supported expedited ability to treat people gravely disabled by substance use disorder and those who raised concerns about involuntary treatment, program oversight, the role of methadone or other medications, and accountability if mandated care fails. Several callers urged careful attention to whether newly funded residential programs would reproduce known problems at past facilities.

County staff and supervisors stressed the request is for funding and implementation clarity; during the discussion the presenters emphasized that the numbers in staff’s planning estimates are preliminary, anchored to likely Lanterman‑Petris‑Short (LPS) hold volumes, and that some components depend on reimbursement policies that the state has to clarify. The staff presentation noted the county anticipates seeking state reimbursement mechanisms in addition to any other funding sources but did not present a single consolidated dollar total in the board presentation before the vote.

Action taken: The board directed the CAO to send a letter to the governor requesting the resources needed to initiate implementation of SB 43, citing the county’s assessment of infrastructure and program needs. The motion passed unanimously (Joel Anderson — yes; Montgomery Stepp — yes; Jim Desmond — yes; Lawson Reimer — yes).

Ending: Supervisors said the county will continue to develop capacity while asking the state to fund the implementation. County officials indicated they will return with details as state guidance and funding availability become clearer.