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Behavioral health budgets spike as CalAIM expands services; board defers final approval pending detailed review
Summary
Behavioral Health Director reported CalAIM‑driven growth in billable service units and resulting cost increases, including large contracted hospitalization and residential placement costs; the board approved a small alcoholism program budget and asked for a detailed briefing and options before approving the larger mental‑health and substance‑use budgets.
Behavioral Health Director presented a fiscal snapshot showing rapid service expansion under California’s CalAIM reforms, with service units rising approximately 200% since CalAIM was introduced and a projected combined mental‑health and substance‑use budget increase from about $46.5 million to roughly $63.6 million for fiscal 2026‑27.
The department said contracted services—particularly out‑of‑county psychiatric hospitalizations and residential placements—have driven most of the growth. Under CalAIM payment reforms the county must provide a share‑of‑cost (an intergovernmental transfer) for many billable services; Behavioral Health staff reported the county’s IGT costs have increased roughly 108% since CalAIM went into effect. The department also said it is pursuing administrative‑claiming reimbursements to capture previously unclaimed administrative costs.
To manage costs, the department proposed reducing vacant positions (net reduction of nine allocations in mental health) and requested two part‑time outreach positions funded by continuum‑of‑care funds for homelessness outreach. Supervisors asked for more granular service‑level metrics and a multi‑year projection before final budget approval. The board approved the narrow alcoholism program budget (4018) but deferred final votes on the larger behavioral health budgets until staff can present detailed scenarios and reserve implications at a follow‑up session.
Next steps: Behavioral Health will deliver a detailed two‑hour briefing and multi‑year cost projections, supply administrative‑claiming updates and vacancy‑reduction impacts and propose options (service prioritization, potential funding sources) to the board at the next meeting.
