Date: Wednesday, February 25, 2026

Time: 9:30 a.m. – 3 p.m.

DHCS Staff Presenters: Michelle Baass, Director; Tyler Sadwith, State Medicaid Director; Yingjia Huang, Deputy Director, Health Care Benefits & Eligibility; Autumn Boylan, Deputy Director, Office of Strategic Partnerships; Paula Wilhelm, Deputy Director, Behavioral Health
Erika Cristo, Assistant Deputy Director, Behavioral Health

SAC Members in Attendance: Adam Dorsey, Al Senella, Amanda Flaum, Anna Leach-Proffer, Beth Malinowski, Brianna Pittman-Spencer, Carlos Lerner, Chris Perrone, Christine Smith, Danielle Bradley, Faith Colburn, Janice Rocco, Katie Rodriguez, Kim Lewis, Kiran Savage-Sangwan, Laura Sheckler, Le Ondra Clark Harvey, Linda Nguy, Marina Owen, Michelle Cabrera, Michelle Gibbons, Rosario Arreola Pro, Ryan Witz, William Walker

BH-SAC Members in Attendance: Adrienne Shilton, Al Senella, Angela Vasquez, Catherine Teare, Danielle Bradley, Gary Tsai, Hector Ramirez, Jason Robinson, Jei Africa, Jessica Cruz, Jevon Wilkes, Karen Larsen, Kirsten Barlow, Kim Lewis, Kiran Savage-Sangwan, Le Ondra Clark Harvey, Michelle Cabrera, Rebecca Sullivan, Robert Harris, Rose Veniegas, Veronica Kelley, Vitka Eisen, William Walker

Additional Information: Please refer to the PowerPoint presentation used during the meeting for additional context and details.

­Introduction and Summary of Content

• The joint SAC/BH-SAC meeting addressed topics related to Medi-Cal and California’s behavioral health landscape. Panel members received a Director’s update on the Governor’s 2026-27 proposed budget, Behavioral Health Transformation, the Managed Care Organization (MCO) Tax, and limited dental benefits for certain adult immigrants beginning July 1, 2026. The following topics were also covered during the meeting:
  • Implementation Plan for New Eligibility and Enrollment Changes Under H.R.1
  • Justice-Involved (JI) Reentry Initiative
  • Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT): Children and Youth Implementation Updates
  • CalAIM Section 1115 Waiver Renewal Public Hearing
• The meeting concluded with a public comment period, allowing attendees to provide feedback to DHCS and panel members.

Topics Discussed

Director’s Update

Michelle Baass, Director

DHCS opened the meeting by providing an overview of the Governor’s 2026–27 proposed budget, which allocates $343.6 billion to health and human services, including $229.1 billion for DHCS, with most funding directed to local assistance and continued emphasis on equitable access to care. DHCS highlighted major fiscal impacts from federal H.R. 1, including increased General Fund costs for immigration‑related Federal Medical Assistance Percentage (FMAP) changes and savings from policy shifts, such as work requirements and eligibility redeterminations. Behavioral Health Transformation updates included upcoming deadlines for county Integrated Plans, significant progress on Behavioral Health Services Act (BHSA) county policy manuals, and extensive stakeholder engagement resulting in multiple plan approvals and new resources. Additional updates included the launch of the Licensing and Certification Portal to modernize application processing, recent Behavioral Health Continuum Infrastructure Program (BHCIP) facility openings across several counties, revisions to the Single Streamlined Application (SSApp), upcoming Medi-Cal dental benefit restrictions for certain adults without satisfactory immigration status, and federal changes affecting the future of California’s MCO Tax.

Discussion

• A member acknowledged the rapid pace of budget developments and noted that, although federal guidance from the federal Centers for Medicare & Medicaid Services (CMS) is still emerging, the budget did not address the forthcoming state Medicaid directive that will bar federal claiming for individuals with Unsatisfactory Immigration Status (UIS) starting in January 2027. The member also observed that the budget continues to assume a risk‑based, capitated arrangement with health plans, and asked whether that remains the approach. DHCS responded that it is still evaluating options considering the 2027 change and will provide additional information once DHCS finalizes its plans.

• The member asked about ongoing data sharing between CMS and the U.S. Department of Homeland Security (DHS), expressing concern about protecting program enrollees, particularly vulnerable communities, from immigration‑related data use. DHCS explained that CMS currently requires the state to submit monthly information on individuals with UIS because emergency Medicaid services are delivered through a capitated, risk‑based system. Although California has led litigation to stop CMS from sharing this data with DHS and has issued a public statement outlining its concerns, the state must continue submitting required data to avoid jeopardizing federal funding. DHCS noted that if emergency services shift to a fee‑for‑service (FFS) model, as outlined in CMS’ recent Medicaid Director Letter, data submissions would be limited to UIS members who actually used emergency services, reducing, but not eliminating, data transmission.

• A member asked about the timeline for translating the new SSApp into all threshold languages, noting challenges for non‑English speakers, and also inquired about public‑facing materials to notify individuals with UIS about the loss of dental coverage. DHCS explained that the application is currently being translated into 19 languages, with phased releases, starting with the most commonly used languages, expected by early summer. DHCS also noted that the Medi-Cal Dental Services Division is preparing outreach letters for both managed care and FFS members to inform them of the upcoming change, and those materials are currently being reviewed for readability.

• A member asked whether DHCS would offer a single, centralized place to view the status of all Integrated Plans. DHCS confirmed that such a comprehensive posting will be made available in the future.

• A member emphasized the positive community impact of mobile crisis services, noting successes, such as diverting individuals from emergency rooms and reducing law enforcement involvement, and asked whether DHCS would consider adjusting the criteria, given the high costs and benefits counties are seeing. DHCS responded that the shift to making the benefit optional is driven by the state’s fiscal constraints and structural deficit, but DHCS remains open to continued collaboration with counties on refining the benefit definition and any parameters that may need to evolve.

• A member voiced strong opposition to reducing coverage for immigrants and cutting community‑based mobile crisis services, warning that such reductions would likely increase hospitalizations, shift costs, and ultimately fail to produce savings. The member then asked about the anticipated end‑of‑year MCO Tax and how DHCS plans to address the resulting loss of funding. DHCS responded that CMS’ final rule confirmed the existing MCO Tax will remain in place through the end of the current waiver period, providing more time than previously expected. DHCS is now evaluating options for the tax moving forward, ensuring compliance with new H.R. 1 requirements and Proposition 35, but noted that no new tax structure has been approved for January 1, 2027, and discussions on alternatives are still underway.

• A member raised concerns about accessibility during the Integrated Plan public comment process, noting recurring barriers faced by people with disabilities, seniors, immigrants, and others when attempting to participate in virtual or hybrid meetings. The member asked what concrete strategies the state will implement in 2026 to ensure inclusive engagement, especially given staffing shortages and past challenges in providing accommodations. DHCS responded that, as counties transition from the Mental Health Services Act (MHSA) to the Behavioral Health Services Act (BHSA), DHCS will closely review how counties document and incorporate public input, including required summaries of recommendations and revisions. DHCS noted that counties may use administrative funds to support multiple modalities for public comment, including web‑based approaches, and stated it would take the request for expanded virtual meeting access under consideration. DHCS also emphasized that counties must demonstrate engagement with required stakeholder groups under SB 326, and this documentation will be part of DHCS’ review of Integrated Plans.

• A member thanked DHCS for its transparency and highlighted the long-standing success of serving children with UIS in organized, preventive-care delivery systems, stressing the importance of maintaining coordinated care for vulnerable groups. The member then asked how DHCS is prioritizing populations, such as children and older adults, as it navigates the CMS directive requiring reevaluation of UIS members in risk‑based payment models, and whether maintaining organized delivery systems for these groups is still feasible. DHCS acknowledged the comments and affirmed that these considerations are actively informing DHCS’ planning as it works through the implications of the federal policy.

• A member expressed strong interest in continuing to partner with DHCS to maintain community‑based mobile crisis services, noting that counties have already made significant enhancements to their crisis systems. The member asked whether reimbursement would still be available if the benefit becomes optional. DHCS confirmed that reimbursement would continue.

Implementation Plan for New Eligibility and Enrollment Changes Under H.R.1

Yingjia Huang, Deputy Director, Health Care Benefits & Eligibility

DHCS outlined the Department’s implementation plan for the major Medi-Cal eligibility and enrollment changes required under H.R. 1, including new work and community engagement rules, six month renewals for the New Adult Group, and restrictions on federally funded coverage for certain noncitizens. DHCS explained that these changes will significantly affect access to coverage, with projected disenrollment affecting hundreds of thousands to more than a million members, depending on the provision. DHCS emphasized guiding principles focused on automation, streamlined renewals, culturally responsive communication, and extensive training for counties and stakeholders to minimize coverage loss. The presentation detailed the stepwise verification process for work requirements, the communication and outreach strategy leading up to implementation, and the roles of providers, navigators, and managed care plans (MCP) in helping members comply with new rules. It also described the transition of many immigrants who will lose eligibility for federally funded full-scope Medi-Cal and move to restricted-scope coverage beginning in October 2026.

Discussion

• A member expressed concern about the growing number of fraudulent calls, texts, emails, and misleading mail targeting people with disabilities and other vulnerable communities, noting that many individuals increasingly turn to AI tools for information despite not understanding the limitations. The member asked what strategies the state might use to counter misinformation, ensure accurate guidance, and address privacy risks as AI becomes more integrated into both public use and contractor workflows. DHCS acknowledged these concerns and explained that broader AI strategy falls outside of the immediate scope of the discussion, but DHCS is monitoring these issues and plans to incorporate them into future stakeholder outreach. As DHCS develops its H.R. 1 communications strategy, it intends to create consistent messaging for implementation partners and consider what outreach modalities may best support accurate, trustworthy information.

• A member asked several questions about upcoming work requirement rules, noting that guidance from CMS is not expected until June, and seeking clarity on how DHCS will translate that federal direction into instructions for MCPs. The member also asked if the use of Enhanced Care Management (ECM) providers and Community Health Workers (CHW) depends on CMS’ final rule or if their role is limited to education rather than enrollment support, and if DHCS is still awaiting additional federal guidance. DHCS responded that it is on a tight path to meet the January 1, 2027, implementation deadline and will adjust its approach once CMS issues guidance, potentially requiring a second phase. DHCS emphasized that MCPs should expect ongoing support and direction through monthly engagements, outreach remains a central function not dependent on federal rulemaking, and CHWs can already assist members under the State Plan without waiting for any new guidance.

• A member expressed concern that current outreach plans rely heavily on health plans and providers to communicate with individuals, noting that many community members, especially those fearful of engaging with formal systems, may never receive essential information. They asked if DHCS is considering deeper engagement with cultural informants, trusted community brokers, and local leaders to ensure messages reach people safely and effectively. DHCS responded that community‑based outreach is indeed part of its strategy and will expand through phased efforts supported by additional outreach funding. DHCS noted that it has successfully used similar approaches during the unwinding, plans to leverage Coverage Ambassadors who are embedded in communities, and continues to conduct user testing and develop materials with groups, like the Medi‑Cal Member Advisory Committee (MMAC). DHCS welcomed additional ideas for strengthening this outreach.

• A member asked for more details on DHCS’ plans to create a streamlined process for members to report work activities or exemptions under upcoming federal requirements. DHCS explained that the effort is still in the early design phase, with vendors showcasing member‑facing tools that allow individuals to enter and track monthly qualifying activities. For California, DHCS is envisioning a mobile, browser‑based page for members by January 1, 2027, developed in partnership with its CalHEERS system integrator, Deloitte. A potential second phase after implementation could include a downloadable app with expanded capabilities. DHCS noted it is still determining how to integrate reporting functions into CalHEERS, and that the work remains in its initial design stage.

• A member asked if the state could apply short‑term hardship exemptions more flexibly, such as allowing eligibility to be based on hardship experienced earlier rather than the single month prior currently referenced, if federal guidance ultimately permits it. DHCS responded that it understands the concern and has already raised this issue with CMS, noting that some of the current rules do not align well with real‑life circumstances. DHCS emphasized that any expanded flexibility will depend heavily on CMS’ interpretation, and that DHCS is still awaiting federal partner feedback.

• A member thanked DHCS for its commitment to minimizing harm while implementing H.R. 1 and raised concerns about the lack of dedicated resources in the Governor’s proposal to support county eligibility workers who will shoulder much of the added workload. The member also asked how exemptions would apply to caregivers who are not parents or relatives, including those working in programs like In-Home Supportive Services (IHSS). DHCS responded that it is actively working with counties to assess administrative costs and acknowledged the importance of clarifying exemptions for caregivers. DHCS explained that it is mapping federal definitions of family and caregiver roles, reviewing how these definitions align with household relationships captured in the application, and examining IHSS data feeds to support accurate exemption determinations. DHCS noted that additional federal guidance is still needed before decisions can be finalized.

• A member expressed strong support for DHCS’ outreach efforts but noted that providers face major barriers in helping Medi-Cal members with renewals because many health centers do not consistently receive accurate, timely lists of patients who are due for redetermination. The member urged the state to require MCPs to share these lists on a predictable schedule and highlighted that current navigator funding is far below historical levels, limiting the effectiveness of renewal assistance. DHCS acknowledged the challenge, explaining that while MCPs already generate these lists monthly, delays occur because plans must clean and validate data before sharing it. DHCS added that it has recently improved Medi-Cal Eligibility Data System (MEDS) data fields to reduce validation time and is working closely with MCPs to speed up the workflow and ensure providers receive information as quickly and reliably as possible.

• A member thanked DHCS for its detailed updates and emphasized deep concern that H.R. 1’s work requirements could cause up to two million people to lose Medi-Cal coverage. They also highlighted the heightened risk that immigrants who are not considered “qualified” will be forced from full-scope to restricted-scope Medi-Cal under DHCS’ implementation plan, making them especially vulnerable to coverage loss due to work requirements and six‑month redeterminations. The member reiterated a strong desire to partner with DHCS as the proposal advances through the budget process and urged continued focus on minimizing harm to affected communities.

• A member asked if DHCS plans to strengthen and standardize redetermination data sharing between plans and counties, noting that current processes are inconsistent, labor‑intensive, and often yield inaccurate or incomplete information. They emphasized the need for more granular, actionable data, such as denial reasons, to improve outreach and coordination across plans, counties, and providers. DHCS responded that while it cannot mandate data‑sharing structures due to county counsel restrictions, it has developed a Memorandum of Understanding (MOU) template in the implementation plan to encourage consistent collaboration. DHCS added that it is willing to provide technical assistance and help facilitate discussions, stressing that plans must work directly with counties to establish effective data‑sharing arrangements and should contact DHCS if support is needed.

• A member praised DHCS for its strong partnership and clear communication, and emphasized that with six‑month renewals, plans need earlier and more seamless access to renewal data so providers can incorporate outreach into routine patient interactions rather than scrambling late in the process. They suggested embedding renewal information into existing provider portals and workflows and noted the plans’ willingness to collaborate through local navigation hubs despite data‑integrity challenges. DHCS agreed with the importance of timely data but explained that structural constraints require the state to complete ex parte processes before sending lists to plans to avoid confusing members. DHCS said it will continue exploring ways to compress timelines, improve data flow, and support MCP‑provider collaboration.

Justice-Involved (JI) Reentry Initiative

Autumn Boylan, Deputy Director, Office of Strategic Partnerships

DHCS provided an overview of the JI Reentry Initiative, which connects incarcerated individuals with Medi-Cal coverage, care coordination, and behavioral health supports before and after release to improve continuity of care and stability during reentry. DHCS highlighted significant program progress, including statewide expansion of pre-release services across 31 state prisons and 34 county facilities, more than 23,000 Medi-Cal applications processed in correctional settings, nearly 35,000 individuals screened for eligibility, and more than 159,000 pre-release services delivered. Through member stories, the presentation illustrated how ECM, behavioral health linkages, and Community Supports help individuals address medical, mental health, substance use, housing, and employment needs as they transition back into the community. The presentation also outlined lessons learned from the first year, such as improving the JI Screening Portal, addressing unknown release dates, and clarifying billing processes. DHCS previewed upcoming efforts for 2026, including statewide readiness support, updated tools and checklists, expanded technical assistance, and the development of a MOU to strengthen coordination between MCPs and correctional facilities.

Discussion

• A member expressed appreciation for the focus on children and asked two questions about the JI Reentry Initiative: whether there is current data on the use of pre-release and post-release services, such as medication and transitions, and if the state plans to maintain the 90 day pre-release period despite federal pressure to move to 30 days. DHCS responded that while they are beginning to collect and analyze data across claims, screenings, and service needs, a complete dataset is not yet available. They explained that the federal landscape is still uncertain, with CMS not having approved new justice-related requests, and noted that California is requesting 90 days in its waiver application and intends to strongly advocate for maintaining that timeframe even while acknowledging the competing 30-day federal push.

• A member praised the extensive collaborative work behind the program and highlighted its significance for JI individuals before asking how new federal work requirements might impact this population, given their high barriers to employment and potential eligibility for exemptions. DHCS explained that incarceration itself qualifies individuals for an exemption that extends up to 90 days post‑release, and many JI adults may also qualify for additional exemptions under California’s 1115 waiver criteria, such as chronic conditions or participation in substance use disorder (SUD) treatment. While some individuals may still lose coverage after 90 days of ECM, DHCS expects that overlapping access requirements and exemption policies under H.R. 1 will limit how many are subject to work requirements. They also noted that diagnostic and procedural information captured during pre‑release services will help identify and apply the appropriate exemptions within the waiver.

• A member asked whether individuals are pre-screened for the program upon entering a facility and then receive the full set of services 90 days before release. DHCS explained that screening begins as early as possible, at intake or booking, but because incarceration typically lasts longer than 90 days, the full pre-release service process officially starts 90 days prior to the expected release date. At intake, facilities check Medi-Cal eligibility, initiate applications when needed, and screen for access criteria to activate the appropriate aid code in the state’s screening portal. For county facilities with shorter stays, DHCS has outlined expected steps by days 8, 14, and 30, along with guidance on when to pause the process if incarceration lasts longer than anticipated.

• A member asked whether counties already receiving Providing Access and Transforming Health (PATH) JI Capacity Building funds could continue spending them beyond the waiver’s sunset date and how newer counties coming on board can catch up in implementing PATH requirements. DHCS explained that PATH JI grants are deliverables based and monitored for up to ten years, meaning facilities may continue using funds if they are progressing on approved implementation plans and can document expenditures during future reviews or audits. While the waiver does not require correctional facilities to spend down funds, DHCS must ensure dollars are disbursed, and counties must maintain records showing they were used for reentry related purposes. DHCS also noted that all county correctional facilities, not just early adopters or those already live, received PATH allocations, ensuring newer counties have funding available as they come onboard.

• The member asked how DHCS is tracking Medi-Cal suspension, enrollment continuity, and required screenings for JI juveniles and adults, especially given new federal rules that will prohibit termination during incarceration starting in 2026, and whether suspension data could help ensure compliance with future work requirements. DHCS responded that it has updated its suspension policy and actively monitors compliance through county guidance, direct reports from correctional facilities, and internal investigations when issues arise. DHCS explained that all individuals receiving pre‑release services under the 1115 waiver are entered into the JI screening portal, which connects to the MEDS and applies a JI aid code that allows pre‑release service claims and supports tracking after release. While the JI aid code is temporary and not meant to label people indefinitely, it enables DHCS to ensure members remain enrolled, receive timely post‑release services, and are connected to MCPs and county-level follow-up. DHCS emphasized that this system allows monitoring of outcomes over time.

BH-CONNECT: Children and Youth Implementation Updates: Policy and Implementation Updates

Paula Wilhelm, Deputy Director, Behavioral Health; Erika Cristo, Assistant Deputy Director, Behavioral Health

DHCS provided an overview of BH-CONNECT implementation efforts for children and youth, highlighting statewide initiatives designed to strengthen behavioral health services, improve coordination with child welfare, and expand access to evidence‑based practices (EBP). DHCS outlined updates to Activity Funds, which will support the well‑being of children and youth involved in child welfare beginning in April 2026, and detailed progress on clarifying coverage for key EBPs, establishing Centers of Excellence, and aligning the Child and Adolescent Needs and Strengths (CANS) tool across behavioral health and child welfare systems. The presentation also covered High-Fidelity Wraparound (HFW) policy development, upcoming requirements for counties beginning in July 2026, and the introduction of fidelity assessments and designation standards. Additional updates included progress on the Access, Reform, and Outcomes Incentive Program; major workforce investments through training, scholarships, and loan repayment programs; and new guidance related to Community Transition In‑Reach services and Institutions for Mental Diseases (IMD) Federal Financial Participation (FFP) program participation.

Discussion

• A member asked how the proposed policy would prevent duplication when a member receives both HFW services and ECM, and whether expectations should be formalized in an MOU for consistency. DHCS explained that the approach aligns with existing policies that already permit ECM to be provided alongside other care management programs, such as specialty mental health targeted case management. They emphasized reliance on local coordination but welcomed feedback on where additional state guidance may be helpful. DHCS added that for some children and youth, particularly those with complex medical needs, it may be appropriate and beneficial to layer ECM on top of HFW, even though HFW already includes significant care coordination.

• A member expressed appreciation for investments in CHWs, emphasizing their importance as trusted messengers amid widespread misinformation and fear. They asked whether CHWs could be made billable at Federally Qualified Health Centers (FQHC) serving large Medi-Cal populations. DHCS responded that this is not being pursued at this time, noting that some health plans are already providing CHWs in clinics and billing directly, and suggesting that organizations explore similar options with their MCPs.

• A member asked whether education provided by ECM providers and CHWs on changes related to H.R. 1 would simply be included in their existing scope of work without any additional payments. DHCS confirmed that this understanding is correct.

CalAIM Section 1115 Waiver Renewal Public Hearing

Tyler Sadwith, State Medicaid Director

DHCS outlined California’s request to renew its CalAIM Section 1115 demonstration for five years, emphasizing the state’s goal of advancing a more coordinated, person-centered, and equitable Medi-Cal program. DHCS reviewed the foundations of CalAIM, the extensive stakeholder engagement informing the renewal, and the updated goals aimed at strengthening early intervention, reducing system complexity, and improving quality and accountability. The presentation detailed the authorities California seeks to renew, such as reentry services, Drug Medi-Cal Organized Delivery System (DMC-ODS) flexibility, Recovery Incentives, Traditional Healer and Natural Helper services, and the Global Payment Program, as well as new authorities proposed for BridgeCare Pilots and Employment Supports. DHCS also explained the transition of certain initiatives to other Medicaid authorities, the sunsetting of time-limited programs like PATH, and the development of an evaluation plan to assess improved access, reduced avoidable utilization, and stronger system coordination.

Discussion

• A member A member asked how “regional entities” are defined in the BridgeCare Pilot and if DHCS has estimates of potential shared savings, noting that counties may contribute the nonfederal share and might eventually benefit from savings generated through the model. DHCS explained that regional entities would likely be multi‑county groups or joint powers authorities acting on behalf of counties. They clarified that the savings referenced pertain to Medicare savings generated by the pilot, which DHCS hopes to share with CMS to help fund implementation. DHCS added that detailed timelines and specific savings estimates are not yet available and will depend on ongoing discussions with CMS.

• A member voiced strong support for renewing the Global Payment Program (GPP), emphasizing its importance to public hospitals, especially as they face significant funding cuts under H.R. 1. They explained that the program has been critical in shifting care for uninsured individuals toward outpatient and preventive services, an approach that will become even more important as coverage declines due to new work and community engagement requirements. The speaker also expressed support for proposed program changes, noting that these updates would further encourage preventive care, outpatient services, and improved chronic disease management, and therefore strongly endorsed the program’s renewal.

• A member expressed interest in both pilots and asked how the BridgeCare Pilot would intersect with IHSS, while also voicing strong support for continuing and modifying the GPP to reinforce public hospitals during a challenging policy environment. DHCS explained that BridgeCare is intended to serve individuals who currently do not qualify for IHSS, noting that its inclusion of personal care services effectively makes it a limited extension of IHSS for a small, targeted population.A member thanked DHCS for prioritizing peer support services in the waiver and suggested that because these services are still new and inconsistently implemented across California, the state should consider establishing a Center for Excellence led by subject matter experts to guide consistent, high‑quality implementation of peer services statewide.

• A member thanked DHCS for its presentation and creative work transitioning CalAIM services, then asked if CMS would be able to complete the waiver approval process before the December deadline or if an extension was possible. DHCS responded that they are proceeding under the standard timeline in which the current 1115 waiver ends December 31 and the new five‑year cycle begins January 1, with all necessary approvals planned for that period. They added that DHCS is working closely with CMS and would pursue temporary extensions if needed during negotiations.

• A member thanked DHCS for the renewal draft and for including BridgeCare and Employment Supports, noting that these pilots will be especially valuable given anticipated Medicare cuts and their impact on individuals becoming fully eligible. They suggested that DHCS consider expanding eligibility to include individuals who are not yet enrolled in Medicare so they could receive Medi-Cal support while also being guided into Medicare enrollment, particularly since cuts to the Health Insurance Counseling and Advocacy Program (HICAP) will reduce navigation assistance for these members.

• A member thanked the team for the update and noted that they plan to submit a formal comment letter before the deadline, saving detailed feedback for that submission. They expressed full support for DHCS’ goals in pursuing the waiver renewal and echoed strong support for their public hospital partners in seeking an extension of the GPP.

• A member praised the strong impact of housing programs on managed care members and expressed enthusiasm for continuing them, noting that earlier timing questions had already been answered and that discussions with CMS seem promising. They also voiced support for the two newly proposed programs and asked whether these would launch with the new waiver or at a later point. DHCS responded that the new programs would likely be rolled out in a phased manner rather than beginning on January 1, as additional time will be needed to negotiate program details with CMS.

• A member thanked DHCS for the detailed update and asked for more information about the 1915(b) waiver, specifically when the public comment period would begin and what the general timeline looked like. DHCS responded that public comment is expected to open in the spring, with a public overview of the 1915(b) waiver approach likely to be released in late April or early May.

• A member thanked DHCS for the presentation and for continuing the organized delivery system benefits, noting that giving DMC counties the option to provide outpatient services will make a meaningful difference. DHCS responded that this new approach is being modeled after lessons learned from BH-CONNECT, allowing counties to opt in on an a la carte basis to cover a range of outpatient benefits.

• The member expressed strong support for continuing essential SUD benefits in both ODS and non‑ODS settings, highlighting the importance of recovery incentives, but also noted concern that an a la carte county approach might lead to inconsistent benefits statewide. They then asked about the delivery system for Community-Based Adult Services (CBAS), noting enthusiasm for its transition out of the 1115 waiver into a more stable program structure. DHCS clarified that CBAS is predominantly delivered through managed care today and that this will remain unchanged as the program shifts.

• A member of the public expressed deep appreciation for the state’s efforts, noting that CalAIM has significantly benefited people experiencing homelessness, particularly through access to recuperative care that prevents individuals from returning to the streets. They also raised concerns about limited access to employment supports, explaining that only about 9 percent of people they serve fall into the unemployed or not exempt group, and that uneven county participation could result in some individuals losing health coverage simply because of where they live. While they strongly support the new programs and recognize their importance for those who qualify, they urged the state to ensure fair, statewide access so benefits are not restricted by county lines.

• The speaker thanked DHCS for its work and expressed strong support for the inclusion of employment supports, emphasizing how vital these will be for affordable housing residents ages 55 to 64 who often face barriers, such as ageism. They also shared enthusiasm for the BridgeCare pilots, noting that these efforts help address long‑standing gaps for individuals who are nearly eligible for Medicare and align well with ongoing work at the California Department of Aging.

Public Comment

During the public comment period, attendees were allowed to voice their concerns and offer feedback to DHCS and panel members.

• A member of the public expressed deep concern that H.R. 1 could cause up to two million people to lose Medi-Cal coverage and emphasized appreciation for DHCS’ work to increase ex parte renewals to reduce disenrollment. They highlighted the critical role community-based organizations (CBO) will play in mitigating the impacts, noting that the communities most reliant on CBO-delivered services are also those most vulnerable to H.R. 1. However, CBOs are facing increasing pressure as they absorb gaps between CalAIM requirements and insufficient reimbursement rates while managing growing operational and cash‑flow complexity with counties and MCPs. The commenter urged collaboration with DHCS to reduce harm, including potentially using H.R. 1‑related cost savings to support individuals who lose coverage and to strengthen CBOs that provide essential services.

• A member of the public expressed concern that the community planning team in Los Angeles County was not given the opportunity to review the Integrated Plan before its submission due to a technical issue, emphasizing that although a public comment period exists, stakeholders still want assurance that their voices are being heard. They also noted an ongoing issue in which the City of Los Angeles is noted as the local health jurisdiction that overlooks the two additional local health jurisdictions within Los Angeles County. They urged efforts to improve recognition, collaboration, and coordination with all local health departments involved.

Adjournment and Upcoming SAC/BH-SAC Meeting

DHCS thanked members of the committee and the public for their participation before providing a reminder for the upcoming meeting.

• The next meeting is scheduled for May 20, 2026.

• The Joint SAC/BH-SAC will continue to be hybrid until further notice.