Faced with the increasing possibility of significant Medicaid cuts, San Diego County supervisors did not back away from further mental health care investments Tuesday, approving requests for additional inpatient and outpatient contracts that would add an estimated $15 million to the fiscal 2026 budget.
Board unanimously ed, with Supervisor Jim Desmond absent, pursuing plans to contract for the equivalent of 30 additional behavioral health beds managed by Paradise Valley Hospital in National City, nearly doubling the amount of space reserved by the South Bay health system for San Diego County Medi-Cal beneficiaries. Additional contracts for a new “partial hospitalization” program with a 35-patient capacity, and for additional board and care beds and chemical dependency treatment beds, also made the list.
Luke Bergmann, director of behavioral health services for the county, made a final report on the progress of the “Optimal Care Pathways” plan his team put together in 2022. Having recently announced his departure from his current post to spend more time with his family and also to take an undisclosed job in the private sector, it was the director’s final presentation to the board.
He emphasized that, while some of the projects listed represent expansions of work that his department is already doing, some, like the partial hospitalization program, are new.
“This would mark the first Medi-Cal-accessible day treatment options for adults in the county,” Bergmann said.
Partial hospitalization is a mode of mental health care delivery that has participants visit hospitals for treatment during the day but return home overnight. Such programs are often favored for their ability to address more severe mental health care needs without keeping patients in locked units full time.
An existing partnership with the Viejas Band of Kumeyaay Indians, which runs an opioid treatment program under contract with the county, is also poised to expand its capacity, starting with 150 treatment slots, recently expanding to 200 and now with discussions underway to reach 250.
Board and care facilities, where people live after receiving intensive treatment, often in locked hospital units, are also expanding with the help of a $44 million grant from the state Department of Health Care Services. In March, the county expanded two additional board and care contracts, adding capacity for 55 more residents. That increase followed awards in February to work with four newly-licensed providers, issuing contracts that could house 166 residents.
Recent additions bring the total number of board and care lots to 475, a 97% increase compared to 2022 when the Pathways program launched.
But the formal write-up of Tuesday’s behavioral health actions included a note that the county has budgeted $390 million in expected Medi-Cal funding this fiscal year and an even larger allocation in anticipation of a new Medicaid “waiver” program scheduled to start next year. Given the rampant speculation nationwide that Congress will soon make deep cuts to Medicaid, called Medi-Cal in California, it remains to be seen just how sustainable the current list of investments will be.
“Potential policy changes at the federal level could directly impact (Behavioral Health Services’) ability to expand and financially sustain Medi-Cal programs, with initial proposals resulting in significant potential revenue losses across BHS mental health and substance use programs,” Tuesday’s board letter states.
Rather than dwell on this possibility, or call for a halt to further investments until the federal funding picture resolves, supervisors instead took turns bidding Bergmann farewell and welcoming acting director Nadia Privara. Privara, who holds a master’s degree in public istration from San Diego State University, ed the county in 2005 and the behavioral health team in 2014, most recently serving as assistant director.
Terra Lawson-Remer, acting board chair, called the complex list of service expansions “a real shining light of what we’ve done at this county.”
“Dr. Bergmann, I hope we can continue working together in some incarnation in the future,” Lawson-Remer said.
Supervisor Joel Anderson, whose district covers most of East County, thanked Bergmann for ing a new behavioral health center in El Cajon, now under construction.
Supervisor Monica Montgomery Steppe echoed her colleagues’ praise, calling out Bergmann’s unflappability in the face of often-critical public commentary.
“There’s a lot of misunderstanding, misinformation and stuff out there,” Montgomery Steppe said. “Thank you for kind of taking the brunt of that with grace for the time that you have been here.”
