Debbie Lindis, Healthcare Delivery System Group Manager at OKA, walked the group through the agency's behavioral health (BH) spending definition and clarified how claims and non-claims payments will be identified and allocated. "The main test is whether the claim includes a behavioral health diagnosis as its primary diagnosis," Lindis said, and she noted an exception for screening and assessment claim lines that can be counted without a primary BH diagnosis.

Lindis said pharmacy claims will be identified as BH by national drug codes and that every claim can be categorized as mental health or substance use disorder to permit separate reporting. For non-claims payments, OKA will apply multiple allocation methods: classifying population-health, behavioral-health integration and care management payments as BH when paid to behavioral health providers; attributing 100% of behavioral health capitation to BH; and applying a formula-based allocation for other types of capitation (an approach analogous to primary care capitation allocation).

Summarizing Advisory Committee and Board input, Lindis said stakeholders urged inclusion of behavioral health delivered in primary care and consideration of secondary diagnoses. "There was a request to analyze claims and spending for secondary behavioral health diagnoses and OKA is planning to conduct some HPD analyses to identify spending associated with secondary diagnoses," she said. She also said OKA and DHCS collaborated to update measurement methodology for 2026 to include Medi-Cal spending for members under 21 on a defined set of behavioral health services regardless of diagnosis.

On out-of-plan and out-of-pocket spending, Lindis said OKA explored using Medical Expenditure Panel Survey (MEPS) data but found the California sample size too small and the estimates unreliable for state-level conclusions. "These estimates are not very reliable and therefore OKA plans to work with other institutions to make progress on this effort," she said.

Jeff Norris of DHCS described ongoing work to account for county specialty mental health and Drug Medi-Cal organized delivery systems in a managed-care perspective. "This is a very active area of exploration between OCHA and dhcs," Norris said, noting more discussion in the next six to 12 months.

Lindis listed priority HPD analyses OKA will pursue: variation in spending and growth across markets and payers; differences by age and geography; drivers of spending growth (price versus utilization); analyses of Medicare Advantage and Medi-Cal trends; and analyses to evaluate impacts of including secondary diagnoses on measured BH spending. OKA plans to present those analytic results to the work group and to include 2024'2025 BH spending results in OKA's 2027 public report.

Closing: OKA invited public comment on the 2026 draft DSG when it is posted and will continue collaborating with DHCS and county partners to refine methods and include county specialty mental health spending in future measurement.