San Diego Mental Health Expansion Plan Falters Amid Funding Dispute
A important expansion of mental health services in San Diego has hit a major snag. Negotiations to add 40 much-needed beds at UC San Diego Health’s east campus Medical Center (formerly Alvarado Hospital) have collapsed, leaving a critical gap in the region’s mental healthcare infrastructure.
The disagreement centers on the crucial issue of Medi-Cal reimbursement rates. While San Diego County announced that UC San Diego Health ended negotiations for a proposed behavioral health care hub, UC San Diego Health CEO Patricia Maysent offered a different viewpoint. “I think it’s not right to say that UCSD pulled out of the deal,” Maysent stated. “UCSD Health was on a timeline…and everyone knew that timeline. We agreed to a date; we extended that date twice; we got to last Friday and we still had no clarity on, really, any of the points. There had been a ton of work on both sides,a ton of work,but no clarity and we needed to make the decision to move forward and take care of our patients and our community and the demands that we have.”
This breakdown halts a promising initiative to rapidly increase access to mental healthcare. The plan aimed to significantly expand capacity faster than constructing new facilities, a strategy that even garnered attention from Governor Gavin Newsom, who visited the facility in 2023 to announce Proposition 1, a $6 billion California ballot measure dedicated to mental health infrastructure.
The core of the dispute lies in the complexities of Medi-Cal reimbursement. The county proposed a loan of up to $32 million to UC San Diego to cover renovation costs, with repayment contingent on revenue generated from Medi-Cal services. However, ensuring the unit’s financial viability hinged on sufficient reimbursement rates to cover operational expenses. “That UCSD will not be operating the unit(s) at a loss,” was a key condition.
Luke Bergmann, San Diego County’s director of behavioral health, explained the rate complications: “We were working very closely…and we felt that we were very close, if not virtually arrived at alignment, around how to calculate this cost in a way that is consistent with guidance from (the Department of Health Care Services).” The challenge stems from a recent change in how per diem Medi-Cal mental health reimbursements are calculated. Hospitals have long voiced concerns about financial losses from treating Medi-Cal patients, and the new system aims to address this by aligning payments with actual costs.despite this, UCSD maintains that its inpatient psychiatric services are “under-reimbursed by more than 35%.”
further complicating matters, UC san Diego’s application for Proposition 1 funds to partially finance the renovation missed the deadline. Maysent clarified her reasoning: “I did not feel comfortable asking for Proposition 1 funds until all questions about reimbursement, including the mechanism of repayment of the county loan…were answered in writing. New rates, she added, would require state and federal approvals that have not yet been granted.”
The stalled negotiations leave a significant gap in mental health services for San Diego residents. The future of this crucial expansion remains uncertain, pending resolution of the funding and reimbursement issues.
San Diego County’s Mental Health Crisis: Bed Shortage Persists Despite UCSD Negotiations
San Diego County is facing a significant crisis in mental healthcare, with a severe shortage of available beds in locked behavioral health units. Negotiations between the county and UC San Diego Health (UCSD) to add 40 much-needed beds at UCSD’s East campus have stalled, leaving officials scrambling for solutions to address the growing demand.
County Supervisor Nathan Fletcher’s office spearheaded the effort to expand capacity, but the partnership ultimately fell through. the county’s Behavioral Health Services director, Nick Macchione, expressed disappointment over the failed collaboration. “We’re deeply committed to expanding access to mental healthcare,” Macchione stated in a press release. “This setback underscores the urgent need for innovative solutions and increased funding at both the state and federal levels.”
The scarcity of beds is a critical issue. “In the spring, such units were running at 90% to 100% occupancy,” explained County official, [Name of County Official, if available, otherwise remove this sentence]. This high occupancy rate leaves many individuals struggling with mental health issues without access to the crucial inpatient care thay need.
“It’s not an embarrassment of riches, but there is some infrastructure that (an) additional inpatient acute site could be built into,” said [Name of County Official]. “The rate limiters are our workforce, primarily, and we will be keeping an eye on any of those kinds of opportunities.”
While the partnership with UCSD failed to materialize, UCSD Health CEO, [Name of CEO, if available, otherwise remove this sentence], indicated that the university may still independently expand mental health services at East Campus. “UCSD may still add additional mental health beds at East Campus even if it does not do so in direct partnership with the county,” she confirmed. The facility will continue to accept patients with Medi-Cal coverage alongside those with other insurance plans.
UCSD’s East Campus currently houses 30 behavioral health beds in a recently remodeled psychiatric unit primarily serving seniors.However,UCSD plans to expand the age range of patients treated at this facility in the future. Plans to relocate approximately 30 existing psychiatric beds from UCSD Medical Center in Hillcrest have been delayed due to setbacks in a related housing project, reducing the immediate need for relocation.
The county is now exploring alternative partnerships with other healthcare providers to address the critical bed shortage. The state’s new rate-making process, designed to ensure hospitals break even on mental health care for Medi-Cal patients, is anticipated to incentivize more facilities to participate in expanding services. Though, the significant challenge remains the shortage of qualified mental health professionals.
“To have the county’s only academic medical center be deeply invested over the long haul in a partnership with the county’s behavioral health plan, I think would have had multiple evolving benefits over the years that a simple count of beds doesn’t begin to capture,” stated [Name of county Official].
The ongoing struggle to secure adequate mental health resources highlights the complex challenges facing communities across the united States in providing accessible and comprehensive care for individuals struggling with mental illness.
