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Behavioral Wellness highlights co‑response and billing gains while flagging long‑term IMD costs
Summary
Behavioral Wellness reported large gains in medical revenue from improved billing and staff utilization while celebrating co‑response and crisis improvements; it warned that long‑term subacute (IMD) bed costs, not eligible for medical reimbursement, are an ongoing fiscal pressure.
The county’s Behavioral Wellness department told the Board that transformation under CalAIM and Prop 1 has produced measurable operational gains — notably higher billed medical revenue and reduced no‑show rates — while elevating the role of co‑response teams that pair clinicians with law enforcement.
Director Tony Navaro said active management to improve staff utilization and revenue capture nearly doubled medical revenue over two years and helped preserve service levels even as other safety‑net programs face cuts. He credited investments in staff workflows, claim management, and partnerships with SenCal for the improvements. "Medical revenues in the current year are on track to be 94% greater at $84 million than the medical revenue actuals in fiscal year 23‑24," Navaro said.
Behavioral Wellness also described operational improvements in crisis response: faster access‑line response, reduced mobile crisis response times, and ongoing implementation of the mobile crisis medical benefit. Public commenters and supervisors praised local co‑response teams as a best‑practice model that has kept many people out of jails and directed them to treatment.
But Navaro warned the board of a persistent fiscal risk: long‑term institutional (IMD) placements for people with complex, persistent psychiatric needs are not reimbursable under current funding structures, generating substantial county costs that are difficult to predict and manage. The department recommended continued focus on crisis‑alternatives, hospital diversion and regional partnerships to manage those costs.
Navaro said the department has focused on system stability, capacity and partnerships with public safety and the hospital system, and requested no service‑level reductions for FY2627. Policy questions remain about how Behavioral Wellness funds programs that fall outside BHSA/medical funding streams and how long‑term care costs will be absorbed.
"Start where you are, use what you have, and do what you can," Navaro said in closing, citing operational resilience as the department’s day‑to‑day approach.
The Board acknowledged the gains while probing IMD exposure and the department’s contingency plans for an uncertain state funding environment.
