A year has passed since a massive statewide effort called CalAIM began rolling out. Among several significant changes CalAIM promised: An overhaul of the availability of mental health care for young people insured by Medi-Cal, the public insurance program for low-income Californians.

Advocates for youth mental health say they remain enthusiastic about CalAIM’s potential, using words like “game-changing” and “transformational.”

But they also say the new framework is being born at a tricky time. Three years into the pandemic, provider burnout and escalating patient need have combined to create a severe mental health workforce shortage. Meanwhile, community-based organizations that provide many of the mental health services outlined under CalAIM say they feel left out of the loop in important conversations about coming payment reforms.

Gov. Gavin Newsom’s budget proposal — which would delay certain behavioral health investments to combat a projected $22 billion deficit — also risks hampering progress for CalAIM.

“Our members are really panicked right now,” said Adrienne Shilton, director of public policy for the nonprofit California Alliance of Child and Family Services. In September 2022, hers was one of a dozen organizations that signed a letter to the state Department of Health Care Services expressing concerns about a lack of transparency around the new rate structure. “Providers must have the ability to plan and prepare alongside their county partners,” it said.

Shilton’s organization also co-authored a letter Wednesday to legislators, decrying the proposed budget delays.

Shilton told CalMatters earlier that other issues CalAIM is meant to address, including alleviating burdensome documentation requirements, have yet to change the on-the-ground reality for many providers.

CalAIM is about much more than mental health. The initiative, short for California Advancing and Innovating Medi-Cal, is a five-year plan that began rolling out a year ago. It aims to provide children and adults insured by Medi-Cal with better access to a range of health and mental health services. It also strives to use a “whole person care” approach to address social issues that impact health, including housing and food insecurity.

It also redesigns the payment system to more seamlessly integrate the county mental health plans and managed care organizations that pay for those services.

The relevance and urgency of addressing children’s mental health is especially clear: Racism. School closures. Online bullying. Climate disaster. A pandemic pocked with grief, loss and fear.

All of these factors have aggravated a youth mental health crisis that’s been raging for more than a decade. Incidence of self-harm for young people, which increased dramatically even before the pandemic, has spiked further in the past few years.

CalAIM has not yet significantly shifted the on-the-ground reality for many of these young people, experts say, but a number of important policy changes are officially underway:

• About 40% of the state’s children and youth are insured by Medi-Cal. They no longer need a formal diagnosis to access specialty mental health services.
• The state has simplified behavioral health documentation requirements.
• A “No Wrong Door Policy” should make it easier for children and adults to receive behavioral health care no matter where they enter the system, replacing what can feel like a bureaucratic maze that varies by county.
• An “enhanced care management” benefit provides services and case management to members of priority populations, including those who are homeless, experiencing early psychosis or involved with the child welfare or criminal justice systems.

Other efforts, including changing the way mental health services are paid for, are also rolling out this year.

Newsom’s administration, which early on made behavioral health a signature issue, is simultaneously unveiling several other ambitious initiatives, all of which require additional staffing and funding: a statewide program to set up new court systems to address the needs of people with severe mental illness, known as CARE Court; expanded crisis response services through state funding for a 988 hotline; and a major initiative to improve mental health care for children and youth, parts of which will be affected by the proposed budget delays.

Despite belt-tightening in other areas of the governor’s proposed January budget, CalAIM continues to be funded. Newsom’s proposal would dedicate more than $10 billion to CalAIM implementation, including $6.1 billion over five years to improve local treatment services and pay for short-term stays in treatment facilities for people with serious mental and behavioral health illnesses.

“We’re committed. We’re not touching that,” he said in a press conference earlier this month.

The budget proposal does, however, delay more than $1.1 billion in other behavioral health investments over the next two years, including money intended to increase treatment capacity for adults and kids in crisis, and money for workforce development. These investments were intended in part to shore up CalAIM’s goals, according to state documents.

“We’re concerned about the delays,” Shilton said. “This is funding outside of CalAIM but … the system is so stressed. Having this additional investment from the state was really beneficial.”

The governor’s office did not respond to questions about the proposed funding delays. He will revise his budget proposal in May, based on actual state revenue, and hammer out a final funding deal with legislators in June.

While CalAIM is an important step toward meeting the mental health needs of vulnerable young people, experts say staffing shortages, especially, are complicating the picture. As a result, some say, it’s not yet clear how and when official policy changes will translate into better mental health treatment for individuals. The proposed budget would delay nearly $400 million for health care workforce training, including some social work and behavioral health pipeline programs.

“Where are the people who are going to be delivering these services?” Shilton said.

Michelle Cabrera, executive director of the County Behavioral Health Directors Association, calls CalAIM “an uber-ambitious reform agenda that’s sitting on top of a system that’s really been through the storm.”

Counties are being asked to implement “ambitious, sweeping new reforms on top of the worst workforce crisis we’ve ever seen,” she said.

In an emailed response to CalMatters, the Department of Health Care Services said the Newsom administration is committed to “collaborating closely” with counties, health plans and others to plan, implement, and monitor the various “unprecedented and intersecting initiatives.”

Still, community-based organizations that contract with counties and managed care organizations to provide mental health services say they are worried about the payment they will receive for their services and how that could affect their ability to recruit and retain necessary staff.

Jodi Kurata, chief executive officer of the Association of Community Human Service Agencies, which represents nonprofit organizations in Los Angeles, said the groups she works with are too overwhelmed dealing with workforce shortages to focus on the administrative transformation underway.

“The system right now is just so depleted,” she said.

She said she worries that inadequate rates could lead to a further exodus of nonprofit mental health providers from the Medi-Cal system, a concern others have echoed.

The state says a preliminary draft of revised payment rates has been shared with counties. The Department of Health Care Services said it has committed to publishing a fee schedule in the first few months of this year.

Cabrera, of the County Behavioral Health Directors Association, said CalAIM’s new payment structure marks an important shift in that the state will now allow counties to pay providers without being capped, and will remove many burdensome documentation requirements. She said counties are just now seeing the new rates, and that the administration’s “aggressive” timeline will likely lead to a “bumpy ride this year” before ultimately resulting in a positive change.

When care depends on your county

Other longstanding funding problems remain unaddressed. This past fall, Young Minds Advocacy, a children’s mental health advocacy organization, published a report showing that longstanding variability in the way the state funds county specialty mental health services has translated into disparities in the kinds of intensive care offered to young Medi-Cal enrollees.

For decades, said Patrick Gardner, an attorney who founded the advocacy organization, the state has underfunded certain counties “and their performance has suffered accordingly, sometimes pretty dramatically.”

In his report, Gardner found that counties with significantly lower-than-average state funding generally provided young people with less intensive services than counties with significantly higher-than-average state funding. According to his report, in 2019-20, poorly funded San Joaquin and Madera counties provided just 16% and 17% of the estimated need for care, while the better-funded Santa Clara and Butte counties provided 86%.

While CalAIM is moving “in the right direction,” Gardner said, it fails to address this fundamental issue. (Cabrera contends that the analysis fails to capture the services that counties provide without billing Medi-Cal.)

Despite these concerns, many mental health advocates say they are already witnessing important changes to the way care is delivered under CalAIM.

“We are seeing shifts happening already,” said Leticia Galyean, CEO and president of Seneca Family of Agencies. She said her organization — which serves youth and families in 14 counties — is especially seeing “an immediate benefit” in terms of faster access to specialty mental health care for foster youth, homeless youth and those involved in the juvenile justice system.

Brian Blalock, a senior staff attorney at the Youth Law Center, which advocates for youth in the child welfare and juvenile justice systems, called CalAIM “the most important thing California has done in a long time.”

“​​There’s just tremendous opportunity there,” he said.

Now, he added, “we as a state can go in either direction — either we realize that promise, or we let this pass us by.”

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CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Patricia Nan Meinhardt, 85, of Ferndale, passed away on November 8, 2022 due to living a long, fulfilling life of joy, love and faith.

Patricia was born on the July 23, 1937 to Blanche and Vincent Casavecchia in the city of Lynn, Massachusetts. After she graduated from High School she enlisted in the US Army and was stationed at Washington D.C. Army Hospital. While serving in the Army she met Don Bowen Sr. and had a son named Don Bowen Jr at Walter Reed Hospital.

Shortly after having Don Bowen Jr, Patricia and family moved to Southern California where she would soon meet lifelong friends Patty Larouche and Shirley Robertson. The three became inseparable and shared a bond as single mothers spending time and raising their kids together.

As a single mother she took on several positions at the Orange County hospital with a focus on diet and nutrition. While working in the health profession and raising her son, she met the love of her life, Joseph Meinhardt, who eventually convinced her to marry him and move to the great northwest in a beautiful Victorian home in Ferndale.

Enjoying her retirement, she spent much of her time involved in community activities such as: The Village Club, The Garden Club, The Ferndale Museum and bocce ball. However, her favorite commitment of all was her devotion to God and being a member of the Church of the Assumption where she attended regularly, read passages at mass, and spent a short time as a Sunday school teacher.

Patricia was a beloved member of her community and was often spotted attending gatherings with her dear friends at local diners and visiting patrons and merchants while strolling downtown Ferndale.

Patricia was predeceased by her parents, Blanche and Vincent Casavecchia, brother Wayne Casavecchia, and husband Joseph Meinhardt. She is survived by her sister Anna Scalia, son Don Bowen, daughter-in-law Donna Bowen, grandson Vincent Bowen and his family Danielle, Liam, and Giddeon, dear friend Shirley Robertson and extended East Coast family.

The Bowen family would like to extend thanks to all who had a lasting memory with Patricia and the warm love, prayer, and thoughts shared.

On the February 4, 2023 at 11 a.m., a service will be held at the Church of the Assumption located at 546 Berding Street, Ferndale. A gathering immediately following where memories, stories and shared laughter can be had in Patricia’s memory. Welcome to all who would like to attend.

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The obituary above was submitted on behalf of Patricia Meinhardt’s loved ones. The Lost Coast Outpost runs obituaries of Humboldt County residents at no charge. See guidelines here. Email news@lostcoastoutpost.com.

Francis Sweet passed away on January 26, 2023 in Fortuna.

Francis was born in Ferndale in 1933 and graduated from Ferndale High in 1951. During high school he worked at the Ferndale Enterprise. While in high school Francis was involved in FFA, and that is where he was introduced to raising sheep. Francis was a private in the Army serving two years in Korea. Upon his return from Korea he went back to work for the Connick Livestock Company and then CalTrans, where he retired, enabling him to ranch full-time in Petrolia.

Francis was an active member of the community and had many varied interests. Francis belonged to the Korean Veterans group and at the time of his passing was their Vice President. He was a member of the VFW in Ferndale. Francis belonged to the Danish Lodge for 62 years and had passed through all the chairs at various points, he belonged to the Dania Lodge, he was a member of the Adult Danish Dance Team, performing at the Scandinavian Midsummer Festival each year.

Francis was a member of the California Wool Growers association for 64 years, holding various positions during that time, assisting with the annual Wool Growers lamb barbecue in Fortuna. Francis belonged to the Our Saviour’s Lutheran Church in Ferndale. Francis was very knowledgeable of our local Humboldt County and Ferndale history and his own ancestors and their journey to Ferndale. Many reached out to Francis to identify people or places in old photos. Francis loved to play cards, especially Pedro. Francis held an annual 4th of July picnic out at the ranch in Petrolia and provided pit lamb and a dance floor for those who knew how to do a polka. Francis loved to dance — square dancing and Danish Folk dancing were two of his favorites.

Francis is survived by Delores Scales, his children, Connie HagQuist (Ron), Becky Sweet, Sandy Aguiar, Clara Sherrill (Gary) and Daniel Barney (Silvana). He is also survived by his 16 grandchildren, Hannah HagQuist, Rachel HagQuist, Justin Ammons, Crystal Sweeney, Alexis Aguiar, Mariah Aguiar, Ray Sherill, Keith Sherrill, Amanda Bunnell, Katina DeNune, Jamie DeNune, Tony DeNune, Clayton Johnson, Jessie Johnson, Kevin Barney and Tamara Barney and 18 great-grandchildren and 3 great great-grandchildren. Francis was preceded in death by his parents, Claude and Mildred Sweet, his second wife Lorana Sweet, daughters, Lynne Johnson and Dona Callender, son-in-law Mark DeNune, granddaughter Lorana Johnson and great-grandson Wesley.

Services for Francis will be held on February 11, 2023, at 11 a.m. at Our Saviour’s Lutheran Church, 425 Shaw Avenue, Ferndale CA 95536, with a Celebration of Life to immediately follow at the Danish Hall, 430 Ocean Avenue, Ferndale.

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The obituary above was submitted on behalf of Francis Sweet’s loved ones. The Lost Coast Outpost runs obituaries of Humboldt County residents at no charge. See guidelines here. Email news@lostcoastoutpost.com.

Paul Leo Steiner passed away on Sunday, January 29, 2023 at the age of 88. Paul was born on April 1, 1934 in Los Angeles, California. Paul was drafted into the Army in 1952 and served until 1955. He saw active duty during the Korean War. When he returned to the States he relocated to Humboldt County where he lived until his death.

Paul spent over 20 years working for Eureka City Schools. Paul enjoyed traveling, his adventures included multiple trips to Hawaii, Mexico and Europe as well as a trip to Australia. Paul enjoyed coin collecting as well as spending time at the swap meet.

Paul is survived by his brother John, sister Denise, sister-in-law Emma, niece Mary and nephews, Jeff and Brien.

A graveside memorial service will be held for Paul on February, 3, 2023, at Oceanview/Sunset Memorial Park, 3975 Broadway, Eureka California, at 11 a.m.

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The obituary above was submitted on behalf of Paul Steiner’s loved ones. The Lost Coast Outpost runs obituaries of Humboldt County residents at no charge. See guidelines here. Email news@lostcoastoutpost.com.

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Should California get rid of its gas tax in favor of something more equitable?

As electric vehicles become more and more prevalent, the state is looking for a new way to fund roadway maintenance and repairs that aren’t based on gas taxes. The “California Road Charge Program” would serve as an alternative funding mechanism based on miles driven rather than the amount of fuel used by an individual driver. 

During a presentation to the Humboldt County Board of Supervisors on Tuesday, Lauren Prehoda, Road Charge Program Manager for Caltrans, described the road charge program as a way to “bring that fairness back into the tax system.”

“We’re seeing this greater unfairness in what people are paying in terms of their taxes,” she said. “Basically, we’re taking one collection mechanism and switching it out for another. We’re not necessarily looking at changing how the money is spent. The money is already being spent [on] our state and local roads, transit, active transportation, all those things. We’re looking at one per mile rate for all passenger vehicles … so everyone is paying the same to use the road.”

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Caltrans and the California State Transportation Agency (CalSTA) are working with tribes and rural communities in Humboldt County on the Public/Private Roads Pilot Project. Currently, when a driver is on a private road, they are still paying for the gas tax even though there are no public funds going into the maintenance of that road. The pilot program will utilize GPS technology to differentiate between when a vehicle is driving on a public road versus a private road.

“For example … say you have a farmer who’s driving on his private frontage road that’s exactly parallel to the public highway,” Prehoda explained. “In one case, he should be paying a tax, and in the other he should not. Right now, under the gas tax system, there’s no way that you can differentiate between [the two]. … We also want to understand if there are any tax benefits specifically for rural drivers in embracing those higher-tech solutions.”

Those interested in participating in the pilot project will receive up to $250 in incentives. “Basically, you’ll need to sign up and you’ll have a little device sent to you to plug into the OBD-II Port of your vehicle and you just drive around for six months as you usually would,” Prehoda said. “Then you’ll take some surveys and that’s it.” You can sign up here.

Third District Supervisor Mike Wilson said the road charge proposal “sounds fair” but pointed out inequities between vehicle weight/size and infrastructure impacts.

“How much maintenance, wear and tear on a road [does] a larger, heavier vehicle have?” he asked. “I know that there is a tendency for larger vehicles [to be used] in more rural areas due to work and other things … but I just want to make sure that, at the very least, you guys are considering that because it is not necessarily fair and equitable [for] someone who is using less resources [to] subsidize those who are using more resources.”

Prehoda acknowledged the disparity, noting that “one person’s idea of fairness is not necessarily [that] of another,” but maintained that vehicle weight only becomes an issue at a commercial scale.

“The relationship between weight and the impacts to our transportation system is not linear, it’s actually exponential,” she said. “In the lower ends of the weight categories, there’s really not that much of a difference in terms of the impact to the roadway and bridges. And really, that’s everything around 10,000 lbs and below.  … When you get above that in the commercial vehicle space … that’s where you see significant damage.”

After some additional discussion, Wilson made a motion to accept and file the report, which was seconded by Second District Supervisor Michelle Bushnell. 

The motion passed 5-0.

Life Plan Humboldt Senior Living Community

The board also received a presentation from Life Plan Humboldt, an organization looking to build a resident-run senior living community in McKinleyville. The community – which would offer 144 independent cottages and apartments for residents 60 years and older – would be the first of its kind on the North Coast.

“We’ll provide assisted living level services to people in their homes and memory care all on one campus,” Ann Lindsay, president of the Life Care Humboldt board of directors, said during this week’s meeting. “We’ll have dining and fitness, a wellness center, meeting space, picnic areas and trails. … We really want to provide a lifelong opportunity for learning, growth and wellness, and to integrate into the broader community.”

Life Plan Humboldt experienced a bit of a setback last year after Cal Poly Humboldt snatched a piece of property the nonprofit had been eyeing on the outskirts of Arcata. 

“We’re currently negotiating for property in Mckinleyville that will be part of the McKinleyville Town Center,” Lindsay said. “It’s a fantastic location for us. We’ve surveyed prospective members and they all want to be within walking distance of amenities, and there certainly are a lot of amenities in Mckinleyville. … We have some alternatives, but this is where we’re working currently.”

The organization is hoping to raise $2 million from local individuals, businesses and foundations to pay for pre-financing development costs, Lindsay said. They’re hoping to secure another $2.5 million in one-time state funding to secure the $75 million needed in bond financing to complete the project.

The board expressed support for the senior living community and unanimously agreed to sign a letter of support for the project. 

Privatization of Medicare

The board also received a presentation surrounding the privatization of Medicare through the Direct Contracting Entities (DCE) and Accountable Care Organization - Realizing Equity, Access, and Community Health (ACO-REACH) programs, also known as the “Medicare Advantage” plan.

Two local members of Health Care for All and Physicians for a National Health Program Humboldt, Patty Harvey and Corinne Frugoni, warned us about this issue a few months back. The pair asserted that Medicare “Advantage” is not traditional Medicare.

“They are draining the Medicare trust fund and, unfortunately, that is affecting the solvency of this public trust that we have all paid into,” Frugoni explained during a lengthy presentation to the board. “‘Medicare Advantage’ has convinced individual seniors to sign up for [its] programs with a lot of slick advertising and because premiums are less under ‘Medicare Advantage’. However, what seniors don’t recognize is that it can affect their ability to get the care they need if they become really sick because it affects the solvency of the Medicare trust fund.”

Frugoni and Harvey asked the board to send a letter of opposition to the ACOO-REACH program to California Health & Human Services Secretary Xavier Becerra.

First District Supervisor Rex Bohn acknowledged their concerns but questioned whether “shutting down this program is how we get there.”

“I mean, it was a great presentation – it scared the hell out of me – but I also have to go by what I’ve found out, what I’ve looked at,” he said. “This model has been in place for 31 days and we’re expected to write a letter saying this is the worst thing that’s ever happened? I think we need to be a little more open-minded. … I need to know more information.”

Frugoni pushed back, noting that the program has been in the works for two to three years under its former name, DCE.

Shortly after public comment, Wilson made a motion to approve staff’s recommendation to send a letter to state representatives opposing the privatization of Medicare. Fourth District Supervisor Natalie Arroyo seconded the motion.

Bohn reiterated his reluctance to support the letter of opposition “just for lack of information.” The motion passed in a 3-1-1 vote, with Bohn dissenting and Bushnell abstaining.

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You can find a recording of Tuesday’s meeting at this link.

HUMBOLDT TODAY:  A judge dismisses molestation charges against a local teacher, a family decries the release of their loved one’s killer after three years behind bars, plus California’s teeth are struggling, and more in today’s newscast with John Kennedy O’Connor. 

FURTHER READING:

• Former Wrestling Coach Arrested For Alleged Sexual Assault on Former Eureka High School Student, Says Arcata Police
• Family of Victim Asks, ‘Where’s Our Justice?’ as Teen Killer Gets Released Back Into the Community
• City of Eureka Moves to Buy 5-Acre Parcel Off Myrtle; Acquisition Could Become Part of Proposed ‘Bay to Zoo’ Trail and More
• Judge Dismisses Felony Molestation Charges Against Accused Fortuna Coach, Math Teacher

Want to LISTEN to HUMBOLDT TODAY? Subscribe to the podcast version here.

# # #

HUMBOLDT TODAY is a production of Lost Coast Communications starring John Kennedy O’Connor and produced by Andrew Goff.

This is what it’s going to sound like. Shop With a Cop file footage.

Are you anywhere near Old Town or Target right now? If so, find some earplugs quick.

One of the least-noticed big bummers of the Dec. 20 earthquake was that “Shop With a Cop” was scheduled for that day, and was of course postponed. “Shop With a Cop” is an annual Humboldt County Christmas tradition wherein local first responders escort local kids who might need a nice Christmas present to Target for a shopping trip.

But the event was postponed, not canceled. And we’re doing the do-over now! The kids are gonna get rides in police cars and fire trucks and ambulances from their gathering spot at the Wharfinger all the way down Waterfront Drive and it’s going be a blast.

Now, what’s one thing you gotta do when you give a little kid a ride in a vehicle that is equipped with a siren? That’s right — you gotta blare that siren absolutely as loud as you can. 

So imagine several dozen of these vehicles parading down Waterfront at low speed with all the sirens cranked to 11, and what you’ve got is a recipe for a panicked public. Tsunami? Air raid? End of the world?

None of these things. It happy kids and happy cops having a blast! It will end soon.