Healthcare is too expensive and too hard to get for too many of us. It’s one of the main issues I hear when talking to folks. This is why I’m excited to share that the County is poised to make significant improvements to how we provide behavioral health, and nearly double our capacity to provide care. 

But there’s a big problem unfolding at the same time that could derail us: threats to Medicaid funding at the federal level could eliminate necessary healthcare for thousands of San Diego Regional residents. 

Here’s what we’re doing and here’s what’s at stake.  

San Diego County to Expand Behavioral Health and Substance Use Treatment

As acting chair of the County Board of Supervisors, this week I convened a Special Board Conference to announce a five-year framework to significantly expand our capacity to provide mental health and drug and alcohol treatment to the people in our region who need it most. 

This bold plan will nearly double treatment capacity by 2030, adding almost 16,000 new care slots, helping the County to continue to combat the region’s growing mental health and homelessness crisis. 

However, these advancements depend heavily on continued Medicaid funding, which is now under threat from proposed federal cuts.

Our new expansion plan sets ambitious goals:

• Doubling residential treatment capacity from 4,978 slots to 8,851.

• Nearly doubling outpatient treatment slots from 9,332 to 18,390.

• Increasing housing resources tied to behavioral health from 2,627 slots to 5,033.

So how does this fit into the big picture? Over the last four years, we have added more than 5,100 treatment slots, enhancing access to crisis care, residential and outpatient treatment programs, and long-term recovery support. And these investments have paid off. The increased capacity of Crisis Stabilization Units (CSUs), Mobile Crisis Response Teams (MCRT), and housing-linked behavioral health initiatives have led to a 28 percent reduction in psychiatric emergency room admissions and a 200 percent increase in CSU utilization.

And here’s something important to know: this is about more than addressing behavioral health crises that we see on the street or read about in the news. While we’re working to expand services, we are also working to change the way our healthcare system works so we can give people the preventative care they require before they end up out of hope and out of time. 

County government is building the behavioral health system San Diego needs — one that treats substance use disorder and mental illness as public health challenges. These investments help thousands of San Diegans get the care they need before they end up in crisis, making our communities healthier and safer.

But here’s where the federal cuts could come into play: Medicaid funds over $581 million in behavioral health services for San Diego residents, covering more than 900,000 people. The federal share of Medicaid in San Diego County covers approximately 70% of our Medicaid expenditures.  If these federal cuts proceed, local governments like the County of San Diego may struggle to sustain these critical services. Medicaid cuts would mean fewer treatment beds, fewer crisis teams, and more people cycling through emergency rooms, jails, and homelessness.

At the County, we will do everything we can to fight these cuts and protect our ability to address our mental health crisis and reduce homelessness.

I’ll keep working with other leaders in the region to urge Congress to reject Medicaid cuts and protect these life-saving programs. We’ve come too far to go back.