Kaiser pays $200 million on mental health staffing; Newsom signs reform package

In what it described as a “historic agreement,” the California Department of Managed Health Care announced Thursday that it has settled with Kaiser Permanente over the company’s failure to deliver adequate behavioral health care services to its patients. 

The settlement, CalMatters’ health reporter Ana B. Ibarra writes, includes a $50 million fine (the department’s biggest ever on a health plan) and $150 million in investments over five years to improve Kaiser’s behavioral health programs. 

Two years ago, the department’s help center reported a 20% jump in behavioral health complaints from Kaiser patients compared to the year before, prompting an investigation. It found that in 2021, Kaiser’s average wait time for follow-up therapy appointments was 19 days, exceeding the 10-day legal maximum.

In a statement, the National Union of Healthcare Workers — which represents 2,000 Kaiser mental health workers in Northern California and led a 10-week strike in 2022 — said the settlement “affirms everything that Kaiser therapists have said about their patients’ inability to receive timely, adequate mental health care.”

Gov. Gavin Newsom said Thursday’s actions “represent a tectonic shift in terms of our accountability on the delivery of behavioral health services.” Read more about the settlement in Ana’s story.

Speaking of mental health: As expected, the governor signed two major bills during a ceremony in Los Angeles Thursday, officially placing on the March ballot a $6.4 billion bond issue to support the creation of 11,000 treatment beds and 27,000 outpatient slots for mental illness, plus a proposal to require counties to redirect roughly $1 billion in current money toward housing.

As CalMatters’ health reporter Kristen Hwang explains, they will be unified on the ballot as Proposition 1. 

• Newsom, in a statement: “We see the signs of our broken system every day — too many Californians suffering from mental health needs or substance use disorders and unable to get support or care they need. This will prioritize getting people off the streets, out of tents and into treatment.”

While the legislation was the subject of intense debate by county behavioral health providers, clients and children’s advocates, Thursday’s ceremony was a show of unity. Newsom was backed by city and county officials, the bill authors, labor leaders, as well as families from the National Alliance on Mental Illness. 

Still, Proposition 1 was immediately met with opposition from organizations that represent people with disabilities and clients of county mental health programs who oppose the expansion of involuntary treatment.

• Californians Against Prop 1: “Disrespecting the voters and existing programs, Proposition 1 drastically alters, for the worse, how our state government will approach delivery of mental health and addiction recovery services.”

And earlier this week Newsom signed legislation expanding the definition of who can be placed under involuntary treatment.  

Kristen also dives into a proposal the governor vetoed that would have required health plans to cover hearing aids for Californians age 20 and younger. Newsom has blocked similar legislation before, and his veto message this year cited concerns about costs. The governor pointed to the existing Hearing Aid Coverage for Children Program as an option for patients who do not qualify for hearing aids under California Children’s Services or Medi-Cal. 

But advocates and some legislators argue that the program has been largely ineffective at covering the estimated 20,000 kids and young adults whose families don’t qualify for low-income assistance. 

And because having a hearing aid within the first six months of one’s life leads to much better learning outcomes, this coverage gap leaves many infants and children at risk for developing permanent speech, language and cognitive deficits. To find out more about how this veto will impact children with hearing loss, read Kristen’s story.

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Other Stories You Should Know

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1 State cracks down on groundwater

Nearly 10 years ago, California lawmakers passed the Sustainable Groundwater Management Act to protect the state’s shrinking supply of underground water. Under the law, local agencies have until 2040 to bring critically overdrafted aquifers to sustainable levels.

But as CalMatters’ Rachel Becker explains, not much has changed. That is, until Thursday when state officials for the first time moved to crack down on inadequate local plans that, in their view, do little to stop the impacts of over pumping from getting worse.

The State Water Resources Control Board’s staff is recommending that several San Joaquin Valley groundwater agencies — controlled largely by landowners and agricultural interests — be put on probation. The agencies were already warned by the Department of Water Resources in 2021 that the plans they submitted the year before were not enough to protect the Tulare Lake groundwater basin. 

The basin, where 27 wells went dry in 2022 and nearly 700 others are now considered at-risk, sits in the agricultural region of Kings County, which is home to 146,000 people.

The board will still have to hold public comment hearings and workshops before it’s expected to vote on the recommendation next April. But if it approves the probation, groundwater pumpers could be required to report their usage and face fees of $300 a year plus $40 per acre-foot of water pumped. And larger groundwater users, such as farmers, may have to install meters to measure pumping. 

Paul Stiglich, general manager of the South Fork Kings groundwater sustainability agency, said he hopes that it will have worked out the issues before the public hearing.

• Stiglich: “Allow us to succeed, and don’t hamper us. That’s what probation would do — probation would throw a cold bucket of water on the whole issue.”

Read more about the debate in Rachel’s story. And learn more about California water policy with a detailed look at how California might increase its water supply, and a dashboard tracking the state’s water situation. 

2 Cal State labor strife cools down

From CalMatters higher education reporter Mikhail Zinshteyn: 

Hot labor summer at California State University is turning into temperate labor autumn as three unions representing 26,000 workers have tentatively agreed to multi-year contracts with Cal State leadership.

The deals don’t include all the labor groups, including Cal State’s largest, the faculty union which represents 29,000 workers. But they likely forestall the potential for virtually every unionized worker at Cal State to go on strike, a would-be nightmare scenario for Cal State.

The three-union deal came in stages over the past few weeks, culminating Thursday with the largest of the three, the union representing staff workers, securing 10% raises over two years and then a much-sought-after deal with CSU to put employees on salary steps. With the step plan, each worker gets a 2% raise when they move up the step ladder, securing predictability in pay that workers long sought. The deal is contingent on adequate state funding. If another Cal State union gets higher wages, the staff union can ask for additional raises.

But a labor deal between faculty and the university system appears to be far off. The California Faculty Association wants 12% raises this year plus improvements to other benefits; the system said they can do that over three years or 5% in one year. The union says 12% in one year is necessary to make up for soaring inflation. Cal State says they cannot afford it, even after approving ongoing tuition hikes starting next fall.

Both sides are in mediation, but if that doesn’t result in a deal, the union is threatening to strike.  In two weeks, faculty union leadership is planning to ask members to approve permission to call a strike. That doesn’t mean a strike will happen, but it empowers union leadership to initiate one. Meanwhile, the union could call for a strike through a different legal process called an unfair labor practice strike.

The faculty union’s leadership wouldn’t comment on how Cal State’s deal with three other unions affects its negotiations with the university, but Trevor Griffey, a labor scholar at UCLA, thinks if the union’s membership is fired up enough, a strike could be imminent. 

“A well-organized CFA could still shut the entire school system down,” especially because the faculty union represents full-time and part-time educators, Griffey said. Still, “an even larger strike that included staff could be even more disruptive,” he added.

Faculty are in a strong position, said Stephen McFarland, a labor scholar and a union executive team member at Cal State Dominguez Hills. Cal State’s deal with three other unions is a “divide and conquer” strategy, he said.

Students know that “our teaching conditions are their learning conditions,” he added.

3 Key dates for CA next week

There are two important dates for your calendar next week:

Taxes: Monday is the deadline to file state income taxes for almost all of California. The date was delayed from April 18 for residents in 55 counties covered by federal disaster declarations due to the devastating winter storms. (Residents of Modoc and Shasta had an Aug. 15 deadline, while only people in Lassen had the normal April deadline.) The Franchise Tax Board has more information.

It’s not only the last day to file returns to avoid penalties, but also to become eligible for the earned income, child and foster youth tax credits. 

• State Controller Malia Cohen, in a statement: “These cash-back credits can put hundreds or even thousands of dollars back in the pockets of families struggling to make ends meet.”

The later tax deadline complicated the state budget, which for 2023-24 covered a $30 billion-plus deficit. In the latest revenue outlook, the nonpartisan Legislative Analyst’s Office said revenues could be $9.5 billion higher than projections, but that would still mean a $10 billion deficit for 2024-25. Another caution from the LAO: “It is entirely possible that revenues could end up $15 billion higher or lower than our estimate for 2023-24 and $30 billion higher or lower for 2024-25.”

Earthquakes: Thursday, the state plans to test its MyShake app, which was designed to blare a warning on phones of an earthquake moments before they’re expected to hit. To test its features and to prepare users to take cover, the app will set off an alert at 10:19 a.m. More than 9 million people in California have enrolled in the drill, which will also go off on phones in Oregon and Washington. To participate, register and download the MyShake app for your iPhone or Android device.

Other things worth your time

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Rep. Ro Khanna to debate GOP presidential candidate Vivek Ramaswamy // San Francisco Chronicle

CA Supreme Court lets employees recoup work-from-home expenses // San Francisco Chronicle

Actor’s union negotiations with studies break down // Los Angeles Times

California closer to getting federal firefighting planes // The Sacramento Bee

CA officials launch last-ditch effort to save Chinook salmon // San Francisco Chronicle

Another home insurer retreats from the state // The San Francisco Standard

Prolific LA eviction law firm caught faking cases in court //  LAist

Cruise upgrading SF driverless cars to adapt to emergencies // San Francisco Chronicle

State grants protections for Inyo rock daisy over mining operation // Los Angeles Times

Newsom says Tijuana sewage crisis is a federal issue // The San Diego Union-Tribune