The Santa Clara County Health and Hospital Committee convened on April 15, 2026, to address critical issues impacting the delivery of public health services. The meeting, led by Chairperson Otto Lee and Vice Chairperson Susan Ellenberg, tackled pressing challenges surrounding funding limitations, evolving state and federal policies, and efforts to maintain sustainability in behavioral health and veteran outreach programs.

Funding Challenges for Behavioral Health Services

A significant portion of the discussion focused on the transition from the former Mental Health Services Act (MHSA) to the Behavioral Health Services Act (BHSA), which has introduced substantial strategic and financial adjustments. According to the county’s behavioral health staff, the state’s shift has resulted in an $8 million reduction in projected revenue due to increased withholdings by California. This funding change is compounded by the broader fiscal hurdles stemming from federal regulatory rollbacks, placing increased pressure on counties to navigate shrinking resources.

“When the state withholds additional funds, particularly from what was previously allocated for workforce development and prevention activities, it directly impacts our local capabilities to sustain these critical programs,” explained a deputy director during the committee meeting. Workforce development programs, such as stipends and other enhancement initiatives for mental health professionals, are among those feeling the squeeze.

Vice Chairperson Ellenberg emphasized the need to prioritize funding for programs that deliver tangible community benefits, including school-based mental health initiatives, which are now transitioning to greater responsibility by local school districts. "We recognize that not all districts are equipped equally," Ellenberg remarked, "and it’s our role to provide technical support and track progress to fill service delivery gaps where needed."

The Sustainability of the TRUST Program

A specific point of concern was the future of the TRUST program, a highly utilized mobile mental health crisis response initiative. The program has gained widespread support within the community for its approach of deploying peer counselors and health professionals instead of law enforcement for mental health crises. However, ongoing concerns over sustainability loom large.

The program's $9.8 million annual budget currently relies heavily on Medi-Cal reimbursements, which are expected to cover only about half of the costs. Advocacy is underway to secure additional public and private funding sources. Chairperson Lee described the TRUST program as “essential,” adding, “This is not optional work. We need to find innovative solutions, including public-private partnerships, to expand and sustain these services.”

The Governor’s current budget proposal has introduced uncertainty by potentially making mobile crisis funding optional for counties. Various committee members echoed the sentiment that state-level changes could jeopardize the program not just locally but across California.

Advocating at the State and Federal Levels

James Roderick, a county legislative advocate, voiced concern over the broader implications of state policies that align too closely with federal health coverage limitations proposed by the current administration. These include changes affecting refugee and asylee health benefits, as well as victims of human trafficking and domestic violence who rely on specialized federal visa programs. "It’s disappointing and frankly a moral failure to see the state doubling down on federal cuts," said Roderick. He urged advocates to amplify their voices, stating that the timing is critical as California’s revised budget is due in just weeks.

Suicides Prevention and Veteran Services Update

The committee also received a semi-annual update on the county’s suicide prevention strategies and veteran services. Darlene Escalante, Director of the Veteran Services Office, reported incremental progress in closing enrollment gaps for veterans in need of health care and benefits. Increased collaborations with the VA health system have boosted local enrollment by six additional veterans thus far. Still, a cautious optimism pervaded the discussion as recruitment for newly approved positions remains underway.

Escalante highlighted adjustments to federal eligibility criteria as shaping outreach efforts, with the office targeting veterans who are currently unaffiliated with any services. When asked about timelines, Escalante confirmed that background checks are in progress for potential hires while expressing hope for more timely onboarding.

Public Comments and Community Feedback

Public comments brought additional perspectives to the table, particularly surrounding the TRUST program. Sandra Asher, a member of the TRUST Community Advisory Board, stressed that mobile mental health crisis services provide essential care that is not merely optional but life-saving. Asher added, “Police responses are more likely to result in costly and harmful outcomes. Peer support counselors offer de-escalation and long-term solutions.”

Broader Implications and Next Steps

Chairperson Lee underscored the need to communicate the real-world impacts of cuts to state and federal lawmakers. "People understand dollar figures less than they understand the lives affected behind those numbers," he remarked. The county is also looking at creative avenues, including exploring additional private funding for programs like TRUST.

Efforts to improve Medi-Cal cost recovery mechanisms remain a key area for operational improvement. Training programs for providers to enhance billing accuracy are ongoing. Meanwhile, the spotlight remains on state advocacy to ensure that crucial programs receive support even amid fiscal tightening.

As Santa Clara County and others brace for an uphill battle, the commitment expressed by health leaders and supervisors serves as a hopeful counterweight to the difficult road ahead. “These programs serve as a safety net for our community,” said Vice Chairperson Ellenberg. "We have to remain steadfast in our advocacy."