Interim Executive Director Will Lightbourne briefed commissioners on the state behavioral health landscape, describing how large statewide initiatives intersect with the commission’s portfolio of grants and technical assistance.

Lightbourne framed the presentation around the public system that serves Medi‑Cal and low‑income Californians, and emphasized the interplay among managed care plans, county specialty mental health systems, and a growing set of state initiatives designed to expand access, link services, and develop workforce capacity.

Why it matters

Several concurrent state efforts — CalAIM (in‑lieu‑of services and enhanced care management), peer credentialing, the BH Connect waiver, CYBHI, and the passage of Proposition 1 (BHSA funding) — collectively reshape how behavioral health services are financed and delivered in California. The commission’s portfolio funds and technical assistance projects intersect with those programs and can influence implementation at the county and local level.

Primary items covered

- Peers workforce and SB 803: Lightbourne reviewed California’s peer credentialing implementation. He said approximately 53 counties had opted into the peer reimbursement option, with about 5,300 peers credentialed through the CalMHSA/CalMesA credentialing effort, but only roughly half reported employed. Commissioners and public commenters urged the commission to support better integration of peers into county and managed‑care delivery models and to remove billing barriers that limit peers’ use for mild‑to‑moderate services.

- CalAIM & enhanced care management (ECM): Lightbourne described CalAIM’s goal to use Medi‑Cal resources to address social determinants of health and noted ECM’s role in care coordination and reentry planning. He flagged continuing friction between community‑based organizations (CBOs) and managed care plans over billing, capacity and relationships.

- BH Connect waiver: Approved in late 2024, the waiver creates a set of Medi‑Cal benefits and investments intended to support housing, workforce development, coordinated specialty care (CSC) for early psychosis, and reimbursement for community health workers and clubhouse services. Lightbourne said IMD‑exclusion exceptions and transitional rent supports are among the waiver’s most consequential elements for counties.

- Proposition 1 / Behavioral Health Services Act (BHSA): Lightbourne summarized BHSA’s reoriented focus on people experiencing the most severe behavioral health conditions, the inclusion of substance use disorder services, and the law’s requirement that counties develop integrated behavioral health plans to be reviewed by the state. He noted BHSA’s implementation introduces substantial technical assistance needs for counties that lack housing and program‑planning expertise.

- Children & Youth Behavioral Health Initiative (CYBHI) and BHSSA: The briefing covered CYBHI investments (school‑based services, wellness coaches, dyadic parent–child services) and the Commission’s role funding and evaluating pilot programs. Lightbourne and commission staff described the all‑payer fee schedule for certain school‑based services as a major, but technically challenging, path to sustainability.

- Allcove and coordinated specialty care (CSC): The commission discussed Allcove youth drop‑in centers and funding rounds that have supported CSC clinics for first‑episode psychosis. Staff said California still has far fewer CSC clinics than estimates of need and that new Medi‑Cal billing codes and reimbursement under BH Connect and BHSA may help expand those models.

- EMPATH and peer respite pilots: Staff reviewed the EMPATH emergency psychiatric assessment and observation units funded by the commission and noted licensing and regulatory alignment issues with state health authorities. Commissioners also discussed a peer respite initiative (short‑term, non‑clinical overnight peer‑run crisis services) identified for future grant rounds; staff said more design work and stakeholder interviews are planned before a possible funding solicitation.

Commissioners and public comment

Commissioners asked how the commission could add value to county implementation, notably by supporting CBOs to build billing capacity, elevating peer integration, and creating practical examples (pilot sites) to replicate successful approaches. Commissioner Karen Larson urged that the commission’s strategic plan align more tightly with these statewide reforms so the commission’s investments clearly support statewide implementation challenges.

Public commenters representing peer‑run organizations and advocacy groups asked the commission to press for legislative or regulatory changes that would allow peers to bill for mild‑to‑moderate services (they said current rules exclude such billing), and to make sure Proposition 1 and other funding opportunities do not primarily benefit commercially ready providers at the expense of smaller community organizations.

Ending

Lightbourne and staff told the commission they view several future roles for the commission: 1) evaluate outcomes from current grants and BHSSA pilots, 2) provide technical assistance for county BHSA implementation, 3) support workforce development tied to BH Connect funding and HCAI workforce plans, and 4) test and replicate peer respite and other community‑driven models. Commissioners asked staff to return with targeted recommendations for where the commission can most effectively intervene to improve county implementation and protect community‑based provider access.