A New York Times investigation offers a warning as California weighs the future of mobile crisis services
States across the country are making difficult decisions about how to preserve behavioral health care amid federal funding and budget challenges—and the consequences of these actions are already becoming clear.
The most recent example is Idaho. In devastating detail, a recent New York Times piece outlines how Idaho’s decision to cut its Assertive Community Treatment (ACT) programs led to the deaths of four individuals.
The story serves as a warning for other states as they wrestle with how to handle these impending cuts. The programs affected may differ, but the consequences could be just as severe.
California is dealing with similar difficult choices. For Idaho, it was ACT programs. For California, it’s mobile crisis systems that are at risk.
Behind Idaho’s decision to cut—and reinstate—Assertive Community Treatment (ACT) programs
After Idaho Governor Little signed an executive order requiring every state agency to reduce spending by 3%, the state’s Medicaid contractor decided to cut all Assertive Community Treatment (ACT) programs. The executive order was issued in part due to the Trump administration’s tax reductions and Medicaid funding cuts outlined in HR1.
ACT programs provide intensive, community-based support for individuals with serious mental illness—often those experiencing repeated crises, homelessness, or disengagement from services. The services are delivered directly into the community, and include psychiatric care, substance use treatment, housing support, employment services, and crisis response. Extensive research shows the program’s positive impact—including reducing repeat hospitalizations, incarceration, and homelessness.
“Sheriff Hulse said that after the services ended in December, his patrol teams were carrying out 14 involuntary psychiatric commitments per month, more than double the rate from a year ago, and crisis centers had seen a 28 percent increase in demand.”
New York Times
The consequences came sooner than anticipated. Involuntary psychiatric holds and crisis center calls increased significantly. Providers reported losing contact with the majority of their patients, and within months of losing access to treatment, some were hospitalized or incarcerated. With no team members to check on individuals enrolled in the terminated ACT programs, it ultimately led to the death of four Idahoans.
“We have had four deaths that you can pinpoint directly back to these programs that were done away with. Our sheriffs, our E.R.s and our courts are dealing with the same individuals over and over again.”
Idaho Senator Kevin Cook, New York Times
The impact was so severe that the Idaho legislature reinstated ACT programs in late March, less than three months after cutting the programs. But the damage was done, and rebuilding will take months due to staff members getting new jobs and challenges with rebuilding patient relationships.
“There is a trust broken with the system. Why would they believe you?”
Nurse practitioner Meredith Sievers, The New York Times
Across California, it’s mobile crisis response that are at risk
What’s happening in Idaho is not isolated. California faces a similar inflection point with their mobile crisis systems.
The enhanced federal Medicaid matching rate (FMAP) expires in 2027, which has helped states nationwide build and scale mobile crisis services. By letting federal funding for mobile crisis teams expire, the Trump administration is crippling states’ abilities to sustain these life-saving services. When enhanced federal Medicaid funding expires in 2027, mobile crisis response may become an optional benefit—shifting costs to counties and putting service continuity at risk across California. Unfortunately, instead of backfilling those dollars, the Governor’s January budget proposal has made mobile crisis an optional benefit for counties.
Faced with this significant cost, some California counties could decide to shut down their mobile crisis systems indefinitely. Several counties are currently raising concerns about what this shift would mean in practice:
- Santa Clara: Local Bay Area news outlet Local News Matters reported that due to Medi-Cal funding cuts from HR1, county officials are rethinking future plans for a variety of mental health services—including TRUST, their new mental health mobile crisis programs.
- Lake County: Lake County officials estimate they would absorb up to $1 million of costs annually from the FMAP expiration to sustain their mobile crisis team—an impact that would force deep cuts or end the program altogether, according to The Press Democrat.
- Sonoma County: The Press Democrat also spoke with Sonoma County officials. They may not be shuttering their services completely, but they indicated that the impact will be significant.
The human impact of making mobile crisis benefits optional
Mobile crisis teams are life-saving services that ensure people experiencing behavioral health crises are met by the right responders, at the right time, and in the right setting. Multiple studies have found that community-based crisis response models reduce hospitalizations and incarceration by connecting individuals to appropriate care.
When crisis services are disrupted, the system defaults back to law enforcement and hospital settings that are often ill-suited to respond to behavioral health needs, putting people’s lives at risk.
What happened in Idaho underscores the real-world consequences of funding cuts to behavioral health services. Idaho learned its lesson and quickly reinstated these programs. But it cost four people their lives.
California now faces a similar decision. Making these services an optional benefit risks people’s lives and forces California back to the status quo of criminalizing mental illness. The state must backfill those dollars to preserve the statewide benefit so we can continue building crisis systems that prioritize care over custody.