Orange County Supervisors are starting to grapple with what the future for mental healthcare could look like as they lose funding for key programs, opening questions on just how much support they’ll be able to fund. 

The big shift came after voters approved Proposition 1 last March, which changed how counties were allowed to spend millions of mental health dollars, forcing them to reallocate some money for homeless services and housing according to the state’s legislative analysts office.

That led to a massive funding cut across most of those programs, with county staff reporting they’re set to receive over $100 million less from the Mental Health Services Act this year than they originally anticipated in their projections three years ago.  

Those cuts also come as county staff are set to release their budget proposal on May 21, which they’ve repeatedly warned will not be pretty amidst federal and state funding cuts and liability from the Airport Fire. 

[Read: Santana: Confronting Orange County’s Public Spending Problem]

The debate over funding spilled into public view on Tuesday morning, when supervisors were asked by county staff to drop their contractor who’s handled their suicide prevention and counseling program for over 15 years because they couldn’t get reimbursed through Medi-Cal. 

Didi Hirsch Mental Health Services currently receives over $3 million a year from the county to operate a suicide prevention hotline and offer support services for county residents who attempted to take their own life.

The Santa Ana-based mental health service also provides help for families impacted by suicide. 

But moving forward, county staff proposed switching over their support services to the OC Asian and Pacific Islander Community Alliance at an annual cost of $1.6 million a year, leaving just over half a million dollars for Didi Hirsch to continue managing the suicide hotline. 

Staff highlighted the one reason they picked the Alliance: they’re already greenlit to charge Medi-Cal for services instead of the county. 

“OCAPICA scored higher on the process for that,” said Ian Kemmer, the county’s behavioral health director. 

Multiple Orange County Supervisors put it more bluntly. 

“None of us wants to be so crass as to say it’s money,” said Supervisor Don Wagner. “But at the end of the day, we’ve got to serve the people.” 

Supervisor Vicente Sarmiento highlighted that the costs were a “result” from Prop 1, and said that it would not be sustainable to work with a provider who’s not already certified for Medi-Cal reimbursement. 

“We have this dilemma where we have two providers that are equally strong, and one is able to immediately bill Medi-Cal for these services, and would relieve us of having to backfill that, and another that is in the process,” Sarmiento said. 

Didi Hirsch is in the process of getting their Medi-Cal certification in Orange County according to Kemmer, who mentioned it still may be a few months before they’re officially greenlit. 

Supervisors didn’t make a final decision on who would get the contract, asking for staff to come back with a proposal that could split the contract in two and let both nonprofits get some of the funding. 

But supervisors said that in the future, county staff need to do a better job of making it clear to their contractors that Medi-Cal certification is a necessity. 

“If the litmus test is going to be based on one item, that needs to be bold, red, caps, all over the application,” said Supervisor Katrina Foley, who also noted she needed more information about the budget. 

“It really does seem to boil down to money, and we don’t have that,” Foley said. “We don’t have like the line item, budget, revenue, expected estimates, etc. We don’t have that as part of our review here today.”

Noah Biesiada is a Voice of OC reporter and corps member with Report for America, a GroundTruth initiative. Contact him at nbiesiada@voiceofoc.org.