The Brief

The director of California’s mental health commission traveled to London this summer courtesy of a state vendor while he was helping to prevent a $360 million budget cut that would have defunded the company’s contract.

Emails and calendars reviewed by California Healthline show Toby Ewing, executive director of the Mental Health Services Oversight and Accountability Commission, made efforts to protect funding for Kooth, a London-based digital mental health company the state hired to develop a virtual tool to help tackle its youth mental health crisis. Ewing pressed key legislative staffers to maintain its contract, even as Democratic Gov. Gavin Newsom and lawmakers proposed cuts in the face of California’s $45 billion deficit.

When Ewing and three commissioners — Mara Madrigal-Weiss, the commission chair; Bill Brown; and Steve Carnevale — left for London in June, Ewing wasn’t sure whether he had saved Kooth’s funding. On the second day of their trip, staff informed him that lawmakers had restored the money.

A few days later, he emailed Kooth Chief Operating Officer Kate Newhouse suggestions he had shared with Assembly and Senate staff to improve Kooth’s youth teletherapy app. “We expect you to be involved in whatever we dream up,” Ewing wrote to Newhouse in another email.

It’s unclear why Kooth picked up a $15,000 tab for state officials to travel to London. It’s also unclear why Ewing pushed to protect its app from a spending cut. The commission is a 16-member independent body appointed by various elected officials to help ensure funds from a millionaires tax are used appropriately and effectively by counties for mental health services. Kooth’s contract is with the Department of Health Care Services, which is separate from the commission.

Kooth last year signed a four-year $271 million contract to create Soluna, a free mental health app for California users ages 13 to 25. The app, along with another, by the company Brightline, for younger users, launched in January to fill a need for young Californians and their families to access professional telehealth free of charge. It’s one component of Newsom’s $4.7 billion youth mental health plan.

Ewing, who reports to the commission, started in 2015 and earned $175,026 in 2023, according to The Sacramento Bee. He was placed on paid administrative leave in September pending an investigation. Commission chief counsel Sandra Gallardo said the commission does not comment on personnel matters. Ewing did not respond to requests for comment.

Three commission employees filed whistleblower complaints against Ewing in September with the California State Auditor. They spoke with California Healthline on the condition that their names not be used due to fears of workplace retaliation. They say Ewing’s conduct advancing a private company’s agenda as a public official crossed a line.

The agenda for Thursday’s commission meeting listed a personnel matter to be discussed in closed session. The whistleblowers said Ewing is the subject of the discussion.

Madrigal-Weiss said she couldn’t comment on Ewing’s actions. However, she said the commission supports virtual mental health resources for youth.

“These resources are less expensive and have proven valuable for youth, especially those who struggle to access services in typical brick-and-mortar spaces,” said Madrigal-Weiss, who is also executive director of student wellness and school culture for the San Diego County Office of Education.

Brown and Carnevale didn’t respond to requests for comment.

Kooth is committed to advancing youth access to behavioral health services, said Caroline Curran, of Metis Communications, a public relations firm representing Kooth.

“As a leader in youth behavioral health services with over 20 years of experience in the United Kingdom and the United States, we regularly convene sector-leading organizations to facilitate learning through sharing expertise and diverse perspectives on youth behavioral health,” Curran said.

As California Healthline reported in April, the Kooth and Brightline app rollouts have been slow, with few children using them. In May, Newsom proposed a $140 million budget cut. DHCS Director Michelle Baass said in a hearing that it was due to low use, but the state expects more users to come on board over time.

She told lawmakers on May 16 that roughly 20,000 of the state’s more than 12.6 million children and young adults had registered on the apps, and they had been used for only about 2,800 coaching sessions.

State Sen. Caroline Menjivar (D-Van Nuys) asked Baass at the hearing whether “there’s room to get out” of the contract altogether. Senators later voted unanimously to cut the entire platform budget to save the state $360 million.

Ewing texted a colleague on June 3: “Kooth is freaking out. Is the cut coming from the Admin or the Leg.? Do we know if it’s a done deal?”

State lobbying records show Kooth has paid around $100,000 this year to the firm Capital Advocacy. At the same time, Ewing’s emails and calendars show that he pushed for Kooth’s funding to be retained. For instance, his June 4 calendar shows he was scheduled to meet with Laura Tully, an executive from Kooth USA, at a coffee shop near the Capitol.

The next day, a whistleblower said, Ewing met with key Senate staff members: Scott Ogus, deputy staff director of the Senate Budget and Fiscal Review Committee, and Marjorie Swartz, a consultant for Senate President Pro Tempore Mike McGuire. They said Ewing also discussed Kooth’s contract that week with Rosielyn Pulmano, a health policy consultant for Assembly Speaker Robert Rivas.

“Toby kept saying that ‘California has to have a digital strategy,’” recalled the whistleblower, who attended both meetings. “He kept pushing Marjorie and Scott, saying that he would give them ideas to make the platform better.”

Ewing emailed ideas to the legislative aides on June 10 and 12.

About two weeks later, he and the commissioners left for the seven-day trip to the U.K. According to documents filed with the state Fair Political Practices Commission, receipts, and emails reviewed by California Healthline, Kooth covered the costs of four-star hotels, meals, train tickets, and international flights.

Public disclosure forms show Kooth paid expenses for Ewing, Madrigal-Weiss, and Brown. The forms do not show the company paid for Carnevale’s travel.

Under California law, state officials generally must report travel payments to the FPPC, which Ewing and his fellow commissioners did.

Kooth postponed a mental health investment conference in London in June, emails and documents show, but then organized new events for the California commissioners to attend instead.

On May 23, Newhouse informed Carnevale and Ewing in an email that Kooth needed to postpone the planned June event. Carnevale, a venture capitalist, described the news as “disappointing for all,” especially “because we have already booked trips, including family members of Commissioners who were planning to turn this into a holiday.”

Acknowledging the disruption, Newhouse told Carnevale that she “would like to think creatively as to whether we could try to arrange a meeting where you can talk about the CYBHI,” referring to Newsom’s Children and Youth Behavioral Health Initiative.

“I know though from our conversation that we need to cover the ‘purpose’ of your trip and not sure what is possible or not,” she wrote.

Curran, the Kooth spokesperson, said the company “adapted by holding a knowledge exchange between representatives from international policy institutes, research foundations, and non-profit organizations.”

Madrigal-Weiss defended the trip, which she said included meetings with “members of the government, service providers, education, and finance” who shared ideas on how “to enhance funds for public mental health needs” through private and philanthropic partnerships.

One of the whistleblowers said many of the commissioners back in California were not aware of the trip until their colleagues were halfway across the world. Sami Gallegos, a spokesperson for the California Health and Human Services Agency, said the Department of Health Care Services did not participate in the travel.

Ewing was put on leave before Kooth’s rescheduled conference this month in London.

Although it’s not unusual for state officials to travel overseas — often on the dime of private entities — it doesn’t look good, said Sean McMorris, a government ethics expert with California Common Cause, a nonprofit government watchdog group.

“It looks like undue influence,” McMorris said. “I think a lot of people would view something like this as a way to curry favor. You can connect the dots.”

Kooth has similarly gifted travel to state officials in Pennsylvania, where it had a $3 million contract with 30 school districts. In each case, Kooth invited the officials to speak to highlight their work. Pennsylvania has informed Kooth it intends to terminate the contract.

The 2028 Summer Olympics and Paralympics in Los Angeles are officially two years away, and applications are now open to volunteer at the Games.

Organizers are seeking 60,000 people for roles like providing translation or guiding guests and athletes. They want volunteers for job categories including communications, driving, ceremonies and technology.

The bulk of volunteer positions will be in Los Angeles, with some opportunities in Oklahoma City, which will host a handful of competitions, and the Olympic soccer tournament sites, too.

Volunteering presents a potential way for some locals who balked at high ticket prices to participate in the summer Games, but they're a substantial commitment. Volunteers need to be available for 10 eight-hour shifts during either the Olympics or Paralympics if they want to participate.

A large volunteer program is a regular facet of the Olympics. In 1984, the last time L.A. hosted, nearly 29,000 people volunteered during the event.

To volunteer this time around, applicants need to be at least 18 years old and be proficient in English. Volunteers don't need to be local to Los Angeles or live in the U.S.

The first step is applying through LA28. Selected applicants will then have a chance to be interviewed in person in Los Angeles or online.

This summer's World Cup has been a bonanza for corporate sponsors.

Hydration breaks are "powered by Powerade." Each game crowns a Michelob Ultra "superior player of the match." Even the signs announcing player substitutions have a label slapped on: Rexona deodorant, which is owned by Unilever. They're the "official personal care sponsor" of this World Cup.

This relentless branding is nothing new for major sporting events, but it has provoked outrage in Los Angeles, where protests during the tournament took aim at FIFA's corporate partners, saying they betrayed the city's values.

At a demonstration in downtown L.A. last week, advocates rallied against a number of high-profile sponsors of the tournament, including Home Depot, the official "home improvement retailer" for the 2026 World Cup.

Its signature orange branding has been splashed across tournament activations this summer, but in the L.A. area its parking lots have been the sites of high profile immigration raids. Last summer in Monrovia, a man was killed fleeing ICE activity in a Home Depot parking lot after he ran onto a freeway and was hit by a car. In another incident, federal agents jumped out of a Penske moving van at the Westlake Home Depot and detained 16 people.

" Their parking lots have been turned into hunting grounds," said Miriam Arghandiwal, an organizer with the Boycott Home Depot Coalition.

" FIFA has been intentional in allowing the people's game to become the billionaire's game, and there's no better example of this than its choice in sponsors," she said at the protest.

The group also railed against FIFA partners Hyundai and Kia, citing a 2022 report that suppliers of Hyundai and Kia had used child labor in its Alabama factories. LAist has reached out to Home Depot and the Hyundai Motor Group, which also owns Kia, for comment.

Demonstrators said they wanted FIFA to make corporate accountability a metric of accepting a sponsor.

" We know mega-events like the World Cup can only happen with the support of host communities, local infrastructure and resources, with the workers throughout various supply chains that make these events possible," said Valerie Lizárraga with the nonprofit Jobs to Move America.

The group was also gathered to demand action from the Los Angeles Sports and Entertainment Commission, which runs the L.A. World Cup Host Committee. Demonstrators said they were dissatisfied with the committee's guidance on human rights for the World Cup.

A spokesperson for that commission deferred to FIFA for comment on corporate sponsorships. FIFA did not respond to LAist's request.

Last week, a small group of climate activists also demonstrated outside SoFi Stadium against Saudi energy company Aramco, another major FIFA partner. They were calling on FIFA to drop the fossil fuel giant as a sponsor.

The World Cup is wrapped up in Los Angeles after Friday's quarterfinal match between Spain and Belgium. But advocates rallying in L.A. say they are looking toward the future.

" Things like the World Cup [and] the Olympics are events that are fueled by people," said Father Thomas Carey, a member of Clergy and Laity United for Economic Justice. "The question is, do we hold them to account to take care of and protect the people who work for them and the people who attend their games?"

Next year, Los Angeles will host the 2027 Super Bowl. And the year after that will be the Olympics.

The Trump administration is abandoning its most aggressive attempt to end gender-affirming care for youth nationally, according to an official document obtained by NPR.

The document shows that the Department of Health and Human Services will not be finalizing a proposed rule that would have blocked all Medicaid and Medicare funding for hospitals that provide pediatric gender-affirming care.

The Centers for Medicare and Medicaid Services told NPR in a statement: "CMS does not comment on future rulemaking or speculate on potential actions. The Trump Administration rejects ideologically driven surgical interventions on vulnerable children."

(Surgery is very rare among transgender people under age 18, and the rule applied to all gender-affirming care, which is mainly therapy and medications for children.)

A "victory" for trans rights, but not a "retreat" by HHS

The fact that the Trump administration is backing off from this action is "a victory for people who are defending the rights and interests of trans people," says Sam Bagenstos, a professor at Michigan Law who served as general counsel at HHS under the Biden administration. "But I don't think it indicates a more general retreat from the aggressive posture of the Trump administration."

Bagenstos notes that this type of leverage — a "conditions of participation" rule for the Medicare and Medicaid program — has historically been used by HHS to compel states and hospitals to meet basic health and safety standards. Things like "making sure that you have stockpiles of certain kinds of equipment, making sure that you have certain kinds of emergency protocols, making sure that you have certain staffing ratios," he explains.

The proposed rule was unprecedented, Bagenstos says, because it instead would have prohibited certain kinds of treatments for a certain population. He says it seemed unlawful in a variety of ways. For one, "it violates the Medicare Act, which says that Medicare and Medicaid can't be used to control the practice of medicine within the state — states get to regulate the practice of medicine," Bagenstos says.

Medical groups opposed the change

Normally, HHS would propose a rule, accept public comment for 60 days, and then finalize the rule so that it could take effect. In this case, after proposing the rule in December and receiving more than 30,000 comments, the administration is abandoning the rule. At least in the next year, it will not be finalized and will not take effect.

The American Medical Association and the Children's Hospital Association both submitted comments urging the agency to rescind or withdraw the proposed rule. Major U.S. medical groups say that puberty blockers and sex hormones are safe and can be effective for transgender young people.

Even so, gender-affirming care for youth is banned in 27 states after a flurry of laws passed over the last several years. In the remaining 23 states, many hospital clinics that offer gender-affirming care have continued to operate, while others have shuttered in the past year citing pressure from the Trump administration.

That pressure has come in the form of this proposed rule, another rule that would bar federal Medicaid reimbursement for transgender pediatric patients, and a declaration from Health Secretary Robert F. Kennedy Jr. that aimed to redefine the standard of care. (Interestingly, the press release issued when those actions were unveiled in December is now missing from the HHS website, as is the Kennedy declaration document.)

The Medicaid rule is currently in the final stage of review and appears to be on track to take effect in the coming weeks. A coalition of Democratic-led states sued over the so-called Kennedy declaration and succeeded in blocking it in federal court in Oregon. The Trump administration has not appealed that decision so far.

Protesters who are against gender-affirming care for young people gathered outside Boston Children's Hospital in September 2022.

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Carlin Stiehl for The Boston Globe

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Getty Images

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At the same time, the Department of Justice has issued administrative and criminal subpoenas to hospitals seeking full personal medical files for transgender youth and employment files for their medical providers, although many of those attempts have been blocked in court so far. The Trump administration has also reached settlements with hospitals in Texas and Ohio that involved establishing "detransition" clinics.

And last month, when the Supreme Court allowed states to bar young transgender girls from sports, the White House issued a press release saying that the decision "Bolsters President Trump's Push to Eliminate Transgender Insanity." The release listed actions targeting transgender people across the federal government, from passport markers to military service to research funding.

Will hospitals that ended care for trans youth restart it?

While the Trump administration does not appear to be backing down from anti-transgender actions broadly, its decision not to finalize its most aggressive healthcare rule is significant, says Katie Keith, director of the Health Policy and the Law Initiative at Georgetown University who also worked in the Biden administration. Those other efforts are not nearly as durable as a finalized rule that takes effect, she notes.

The decision of the Trump administration not to finalize this rule "should give hospitals more confidence to either resume or continue offering the care," she says. Because the rule was never in effect, "I would argue that they should have been doing this all along anyway."

Kellan Baker agrees. He's a senior adviser for health policy at the Movement Advancement Project think tank, which focuses on LGBTQ issues. "This administration may have checked itself in one of the most extreme expressions of its agenda and I think people should take solace in that," he says. "But at the same time, this administration is continuing to show that its ultimate goal is eliminating healthcare for trans people and that it is apparently prepared to use almost any means necessary to do so."

The Medicare and Medicaid rule could theoretically be revived at some point, since it has not been formally withdrawn. An entry in the Trump administration's recent unified agenda sets a final action date for the proposed rule as December 2028, just before President Trump leaves office.

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