The Brief

California under Gov. Gavin Newsom has made sweeping changes to its behavioral health system, pouring billions of dollars into new services and support programs.

But the state’s ambitious plans face a looming threat: the proposed federal spending cuts that Congress is currently considering are seen as all but certain to impact Medicaid and could bring to a halt some of the headway the state has made in responding to its behavioral health crisis.

It’s not that all of California’s behavioral health policies are explicitly tied to Medicaid, but many state and local mental health programs draw funding from it. Less Medicaid money means less money for those efforts.

“When you remove resources of this size and scope everything is at risk,” said Alex Briscoe, principal with the nonprofit Public Works Alliance and who previously led the Alameda County Health Care Services Agency. “To be fair, the behavioral health reform landscape of California was just written, and we are still very much moving from promise to practice.

“So it's an extremely difficult time to see such fundamental threats to funding Medicaid,” Briscoe said.

It is unclear what these federal spending cuts will look like, but a budget resolution that passed the House last month proposed $880 billion in reductions over the next 10 years from the committee that oversees Medicaid. Both chambers still need to agree on a joint budget resolution.

Medicaid, the joint state and federal health insurance program for low-income people, pays for the care of four in 10 Californians. It’s through this program, also known as Medi-Cal in the Golden State, that millions can access behavioral health services such as therapy, medication, psychiatric evaluations and crisis support. About two-thirds of California’s $161 billion Medicaid spending comes from the federal government.

It’s also the Medicaid program that helps California pay for some of its social support services for its most vulnerable residents. They include housing navigation and food assistance, which help stabilize people and improve their chances of completing their course of mental health or substance use treatment.

The federal threats to Medicaid funding come at a time when close to half of adults in the state have reported symptoms of anxiety or depression, and about 1.2 million of them live with a serious mental health illness, according to figures by the National Alliance of Mental Illness. When it comes to children, 1 in 6 experience a mental health disorder every year.

Meanwhile, opioid-related deaths skyrocketed between 2018 and 2023, largely because of fentanyl use, state data shows. Opioid overdose deaths peaked at more than 8,000 in 2023 and have been declining since last year.

In response to the grim landscape, Newsom set out to revamp the state’s behavioral health system. This has included growing the number of treatment beds, training new mental health workers, expanding the reach of crisis hotlines and mobile crisis services, increasing the availability of opioid overdose reversal medication, and increasing mental health access in schools, among other changes.

Tents outside the Federal Courthouse in Los Angeles on April 22, 2024.

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Ted Soqui

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CalMatters

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The state pulls from multiple buckets, such as special taxes, to fund its public behavioral health system, but federal funding through Medicaid is an essential piece of it. Across the country, Medicaid is the largest payer for mental health services.

CalMatters asked the governor’s office what Medicaid cuts could mean for the state’s behavioral health system. It released a written statement from Health Secretary Kim Johnson in which she reiterated that the administration had an “unwavering” commitment to ensure that all Californians have access to mental health and substance use disorder treatment.

“Behavioral health care is essential health care for the well-being of individuals, families, and communities across California,” she said. “Investing in behavioral health services saves lives, reduces long-term costs, and strengthens our workforce and economy.”

But mental health advocates, health plans, and county officials put it this way: Medicaid funding cuts would result in more sick people going without treatment. That would increase the likelihood of them losing employment or dropping out of school and ending up in need of more acute care, or worse, on the street.

“There are tons of people on the streets who are struggling,” said Corey Hashida, a senior research associate at the Steinberg Institute, a mental health advocacy organization. “At a time when we're trying to move forward with doing these big things to help those folks, all this uncertainty and chaos is swirling around federal cooperation … it just infuses a little fear into the safety net.”

In a recent policy brief, Hashida explained that in addition to possible funding cuts to Medicaid, key federal behavioral health grants are also at risk. And California has already started to see some of this fallout. On March 24, the California Department of Health Care Services, which oversees the state’s Medicaid program, received termination letters from the federal Substance Abuse Mental Health Services Administration, pulling back $120 million in behavioral health grants.

Those grants, according to the department, were intended for initiatives at the state and local level, including work to reduce overdose deaths and expand access to medications for opioid use disorder.

California could lose billions in Medicaid funding

The feds could roll back Medicaid spending in a number of ways, such as imposing work requirements or restructuring funding formulas. They could also restrict how Medicaid funds are used by ending federal waivers that expanded how California and other states use money from the program.

Policy and budget experts say that it is difficult for states to make contingency plans when it is unclear how or if the cuts will play out.

President Donald Trump has said that he will not touch Medicare and Medicaid as he looks for spending reductions to fund extending his 2017 tax cuts. He has said he will only go after eliminating fraud in the programs. However, the Congressional Budget Office has found that if cuts to Medicare, the insurance program for seniors, are off the table, then Congress would have to make deep cuts to Medicaid to reach House Republicans’ savings goal.

By some estimates, Republican proposals to reduce spending in Medicaid could translate into an annual loss of $10 billion to $20 billion in federal funds for California.

For example, Congress may choose to reduce the matching dollars that the federal government pays states for adults who gained coverage under the Affordable Care Act’s Medicaid expansion. The federal government pays California 90% of the cost for this expansion population — that’s more than the 50% matching rate the feds pay the state for other enrollees.

This expansion allowed many childless adults to access critical mental health treatment, including many struggling with psychosis, said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association. Psychosis is a condition that can result in hallucinations. It typically emerges in late adolescence or early adulthood, but can be treated with medication and therapy.

That expansion “was a game changer,” Doty Cabrera said. “Taking away funding for that population would be devastating.”

Counties are responsible for providing specialty mental health services to people with more serious mental health conditions and substance use disorders. Counties fund these services with their own local revenue, some state dollars and matching federal Medicaid funds.

“There's really nowhere else to go in terms of funding,” Doty Cabrera said. “We're already maximizing local spending to try to support these services, and if the federal funding were taken away, it would just put additional pressure on the state budget that obviously is already facing a tremendous number of pressures.”

Federal Medicaid dollars are a significant portion of counties’ mental health budgets. In Los Angeles County, for example, 30% of the county’s annual budget for its behavioral health services department comes from Medicaid, according to the department. In Santa Clara County, about a quarter of it does.

“So when you're talking about a quarter of the funding for a system, you're talking about the ability of the entire system to function,” said James Williams, county executive for Santa Clara County.

Will Trump extend California health waivers?

California relies on special permission, or “waivers” from the federal government to be able to use Medicaid dollars to fund non-traditional services, such as access to a care coordinator, housing navigation, rental deposit aid, and medically tailored meals. Experts say these types of support services go hand-in-hand with successful behavioral health care, and in the long run should save the state and feds’ money by helping people avoid costly emergency room care.

“Waivers are about granting some flexibility so that you can deliver more holistic services,” Williams in Santa Clara County said. “And one of the biggest challenges in behavioral health care, and this is especially true for substance use care, is having people make it through a course of treatment.” To increase people’s chances, you need things such as stable housing.

Some of these support services are just now starting to reach people. But their continuation is also in the feds’ hands. The federal government has the power to rescind the waivers or let them expire.

Two waiver programs are seen as key to California’s behavioral health transformation because they extend Medicaid funding and flexibilities for these support services. These are BH-Connect, which was just approved by the Biden-Harris administration in December, and CalAIM, for which federal approval is set to expire at the end of 2026.

The Trump administration has not indicated whether it will renew the CalAIM permissions, but given the discussion of Medicaid funding cuts, it is creating some anxiety over the future of the program.

Michael Schrader, chief executive of the Central California Alliance for Health, the local Medicaid plan for people in Merced, Santa Cruz and neighboring counties, said he has been hearing concerns about this from providers in his network.

“Providers are wondering, ‘Do we keep making investments in CalAIM?’” Schrader said.

“I’ve got clinics saying, ‘I did what you asked me to do. I stepped up and I hired community health workers, I hired enhanced care managers, I put together structured programs, we're serving these people, and I continue to make these investments thinking this is long term, and now I don't know.’”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

It can be the small, curved horn of a ram or the dramatic spiral of an African antelope. The sound it creates is unmistakable.

Creating that sound is not difficult, but it does take some practice, said Rabbi Alicia Jo Rabins, a musician based in Portland, Oregon.

You take a deep breath and purse your lips, like you are playing a brass instrument.

Rosh Hashanah, the Jewish new year, begins at sunset Friday. Across the world, Jews will spend the two-day holiday in prayer, reflection and celebration. And for many, a highlight will be hearing the shofar: an animal's horn blown like a trumpet.

How did this primal instrument become a holiday's spiritual soundtrack?

" The most basic answer is that it makes noise, right? It calls people to attention," said Daniel Picus, an associate professor at Western Washington University in Bellingham who researches religious practices and rituals. "All of the instances in which a shofar is used in the Hebrew Bible, that is what it's doing."

Abraham Ribak , an Israeli, blows a shofar, a musical instrument used in Jewish religious ceremonies made from the horn of a ram.

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Ariel Schalit

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Shofar blasts marked the revelation of the Torah at Mt. Sinai and the start of the Jubilee year, Picus said. Priests blew shofars when they circled the walls of Jericho to bring down the walls. The shofar marks moments of heightened experience and emotion — and Rosh Hashanah.

"In the Hebrew Bible, Rosh Hashanah is the day of trumpeting and the day of remembrance," Picus said. "The association of the shofar with Rosh Hashanah is right there in the Biblical text."

Centuries later, the Mishnah, the earliest rabbinic codification of law, drilled down into greater detail in the tractate Rosh Hashanah, laying out exactly how a shofar should be prepared (hollowed out), repaired (it depends), blown (a complex series of blasts at several times during the service, thanks to debate over linguistic interpretation), and whether or not it can be blown when Rosh Hashanah falls on Shabbat (no, although some modern synagogues have changed course).

And within the Talmud and for centuries thereafter, people have debated the meaning of the shofar.

Shofars are on display for sale at the Barsheshet-Ribak Shofarot company, in Tel Aviv, Israel.

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Ariel Schalit

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Rabbi Micha'el Rosenberg, who teaches at the Hadar Institute, a center for Jewish learning based in New York City, pointed to several sources that compare the sound of the shofar to the cry of a mother in pain — the mother of the slain biblical military commander Sisera, and the cries of a woman in labor.

Rosenberg said you can hear that in the sound — especially the broken staccato blasts, known as "teruah."

"You can really imagine someone so caught up that they can't get the full sound out even, that they're gasping with their cries," he said.

Another interpretation comes from Maimonides, the medieval Jewish rabbi and scholar known as the Rambam, who wrote "The Laws of Repentance." He describes the blast of the shofar as a sort of spiritual wake-up call to become your best self.

"In Jewish law, we have this expression of daled amos, my four cubits: I focus on the 6 feet around me, as it were," he said. "It's easy to do that — and there's value in doing that sometimes. But the shofar, per the Rambam, wakes us up and says, 'No, there's more beyond what I can immediately see around me.'"

Rosenberg also pointed to Hasidic theories that the blowing of the shofar reenacts the breathing of life into the world. But he said one of the most powerful things about the shofar is that it doesn't say anything at all. "It transcends my words, it transcends my rational thoughts, and it really is just a feeling that I can hope to hold onto," he said.

Rabins, the Portland rabbi and musician, said the shofar can call across time to speak to those wordless places inside us. "It really brings you into the moment, and you also feel connected to your ancestors, who have been hearing this sound and making this sound for thousands of years," she said.

It's a sound, Rabin said, that can wake you up to all the joy and sadness of life, whether it be a birthday horn or a mother's cry. And it makes you pay attention — both to this moment, and to the year to come.

This story was created through a partnership between NPR and Religion News Service.
Copyright 2026 NPR

TV critics care a lot about the people who bring us the shows we love, so of course we each have folks we're pulling for this Emmy season. The Pitt, Hacks, Widow's Bay and Pluribus are leading the Emmy nominations pack this year. Here's who we'll have our fingers crossed for during the ceremony on Monday night.

Outstanding drama series: Pluribus 

Rhea Seehorn in "Pluribus."

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HBO Max hit The Pitt likely wins here. But Apple TV's Pluribus triumphs as a revolutionary sci-fi story; a virus, created with instructions sent from the stars, unites humanity in a giant hive mind, creating paradise or the largest cult in history. — Eric Deggans

Outstanding lead actor, drama: Noah Wyle, The Pitt 

Noah Wyle in "The Pitt."

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Warrick Page

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It's easy to overlook the massive feat star Noah Wyle achieved on The Pitt's second season; pushing a beloved character to the brink of unlikability. Wyle plays struggling Dr. "Robby" Rabinovich as a good guy in serious crisis, finding new depths. — Eric Deggans 

Outstanding lead actress, drama: Rhea Seehorn, Pluribus 

Rhea Seehorn in "Pluribus."

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<i>Apple TV</i>

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At least half of this show is just watching Rhea Seehorn's Carol all by herself, parsing out the rules of a new post-apocalyptic world while mourning her wife. Yet it's always compelling, because Seehorn is a talent who should already have an Emmy! — Aisha Harris

Outstanding supporting actress, drama: Karolina Wydra, Pluribus 

Karolina Wydra in "Pluribus."

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Apple TV

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Hoping Emmy voters look past the four actresses nominated from The Pitt to honor a performer who brought empathy and depth to a thankless role: Karolina Wydra as Zosia, the voice of the global hive mind, talking to Rhea Seehorn's Carol in Pluribus. — Eric Deggans 

Outstanding comedy series: Margo's Got Money Troubles  

Elle Fanning in "Margo's Got Money Troubles."

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Apple TV's Margo's Got Money Troubles is a comedy nominee that doesn't seem like one. But the story of a young woman leaning into problematic choices to build a life with her baby and quirky family was the year's most surprising, energizing show. — Eric Deggans 

Outstanding lead actor, comedy: Yahya Abdul-Mateen II, Wonder Man  

Yahya Adbul-Mateen II in "Wonder Man."

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Suzanne Tenner

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This nomination was a surprise after Marvel cancelled its creative, quirky superhero series, Wonder Man. But star Yahya Abdul-Mateen II is spellbinding as a superpowered guy who just wants to be a successful actor, blending comedy, pathos and drama. — Eric Deggans 

Outstanding lead actress, comedy: Lisa Kudrow, The Comeback   

Lisa Kudrow in "The Comeback."

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Emma Simkin

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The category's stacked, but Lisa Kudrow's Valerie Cherish threads many needles beautifully: self-absorbed yet caring, oft-humiliated yet resilient, wacky but grounded when necessary. As a character in Season 3 says to her: "To me, you're it." Indeed. — Aisha Harris  

Outstanding supporting actress, comedy: Kate O'Flynn, Widow's Bay  

Kate O'Flynn in "Widow's Bay."

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Apple TV

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It's all there in Episode 4, the one in which Patricia's desperate play to improve her social status — a cocktail party — goes awry. Kate O'Flynn knows this character, what drives her and what makes her so cringe (to us). It's utterly mesmerizing. — Aisha Harris 

Outstanding supporting actor, comedy: Nick Offerman, Margo's Got Money Troubles  

Nick Offerman in "Margo's Got Money Troubles."

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Nick Offerman excels playing macho guys who are more sensitive than anyone expects. But he scales new heights as Jinx, an ex-wrestler/once-estranged dad, struggling with addiction while trying to support his daughter in Margo's Got Money Troubles. — Eric Deggans 

Outstanding writing for a comedy series: The Comeback 

Lisa Kudrow in "The Comeback."

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Erin Simkin

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HBO

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A new season comes around every 10 years (like the census!) to provide us a clear-eyed accounting (like the census!). This show was right about reality TV and streaming services; we ignore this season's dire, hilarious warnings about AI at our peril. — Glen Weldon 

Outstanding limited or anthology series: DTF St. Louis  

Jason Bateman and David Harbour in "DTF St. Louis."

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Tina Rowden

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HBO

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It's tough to explain how a show about the mysterious death of a schlubby guy stuck in a love triangle became the year's most creatively quirky limited series. Somehow, star David Harbour turns this tale of middle-aged desperation into poignant, dark comedy. — Eric Deggans 

And already announced

I'm happy to report that two of my picks already took home their Emmys in a ceremony last weekend formerly known as the Creative Arts Emmys. So congratulations to Betty Gilpin, who won outstanding guest actress in a comedy for Widow's Bay, and to The Muppet Show for outstanding writing for a variety special. (A third pick — Connor Storrie's game, goofball turn as SNL host — didn't end up winning outstanding guest actor in a comedy, but seeing as that award went to the late Rob Reiner for The Bear, I'm not complaining.) — Glen Weldon
Copyright 2026 NPR

A Spanish-language TV singing competition from Mexico is doing something that mega-popular shows like The Voice are not. México Canta brings contestants from the U.S. and Mexico together to share the stage — and cultural ties.

“I am very connected to my Mexican side and those roots, [but] I've never really gotten to perform for such a big Mexican audience,” said Tiffany Galaviz, who performed on the show last month. She was born and raised in L.A. County and lives in Glendale.

The semifinals were held in L.A.’s Orpheum Theater on Aug. 23, and the winners were chosen by hundreds of thousands of people who cast votes online. Galaviz made it through, which means she’ll be one of seven finalists who will perform in the competition on Sunday, Sept. 13 at Mexico City’s prestigious Auditorio Nacional.

Three will be named winners and will receive recording contracts.

“It's a huge, huge venue [that’s]  very important to the Mexican culture,” Galaviz said. “More than anything, I just feel really proud, especially making my family proud. Most of my family is from Sinaloa, and I spent a lot of summers there growing up."

Tiffany Galaviz is a mariachi musician in Southern California.

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Studying mariachi since she was 8

The U.S. semi-finalists included performers from Arizona, Illinois and New York, while finalists from Mexico came from Morelos and Mexico City, among other places.

Galaviz is 24 and first started learning to play violin and sing in mariachi bands when she was 8. She plays violin and sings in mariachis across Southern California now and makes a living from it.

“I signed up for México Canta because I feel like I have everything that I need except the connections, the resources, the producers, the studios,” she said.

Created as an alternative to songs that glorify violence

The Voice and its Spanish-language counterpart La Voz create a platform for celebrity and the potential for stardom. But that’s less so for México Canta. The competition was created by Mexico’s Secretary of Culture to bring together people of Mexican heritage from both sides of the U.S.-Mexico border around songwriting that’s an alternative to music that glorifies violence.

“We’ve strengthened fraternal ties between people in Mexico and the U.S.,” said Claudia Curiel de Icaza, Mexico’s culture secretary, when she presented the seven U.S. semi-finalists at a morning press conference on July 23. The seven semi-finalists from Mexico were presented a week later.

“Youth are front and center in the transformation of culture. [The contest has shown] that music has no borders, and it is furthering fellowship between Mexicans and Mexican Americans,” Curiel said.

Galaviz said that’s another important reason she signed up for México Canta.

She picked the corrido musical genre for the song she performed at the Orpheum. She’s had a love-hate relationship with corridos, she said, because many contemporary songs in the genre glorify drug dealing and violence.

Tiffany Galaviz performed at the México Canta semifinals at the Orpheum Theater in downtown L.A. on August 23, 2026.

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Screenshot from México Canta video.

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“I felt like I could make a positive impact, not just me but the rest of the contestants [too] by doing songs that are a little bit more positive in nature in their lyrics,” she said.

The song is about a breakup and begins with a description of a photo torn in two. It’s about a woman’s heartbreak, she said, “ but then it kind of shifts to an empowerment, you know, of being able to be by yourself as a woman.”

Galaviz began to get teary after finishing the song and talking to the presenter on stage.

“[I'm] proud of being able to represent Mexico and my roots. … It means a lot to have my family here, who’ve always supported me,” she said.

Days after making it past the semifinals, Galaviz had not picked the song she’d sing for the Sept. 13 finals. The performance carries weight for all contestants because it’ll be three days before Mexican Independence Day. Held in Mexico’s capital, the finals will take place in front of thousands of people, with an audience on TV, radio and online on both sides of the border.

Lauren Kim works alongside her father, Hanjik, at his traditional medicine clinic on the border of Koreatown and MacArthur Park. But it took an oral history interview for her to hear parts of his story for the first time.

Filmed speaking in Korean, he animatedly described how he came to traditional medicine.

“It’s just so precious to have that captured,” Kim said.

Now that interview, along with hundreds of others about life in and around Koreatown, is being gathered into the new K-Town Archive in a partnership with UCLA that also includes photographs and ephemera.

The archive grew out of Koreatown Youth and Community Center’s Koreatown Storytelling Program, which launched in 2020 with plans to have young people interview elders. Then COVID-19 hit. Participants pivoted to delivering necessities for older residents such as masks and disinfectant.

They also started documenting what people were going through – in English, Korean, Spanish and Bangla. A current offshoot project involves interviewing people who live or work along the stretch of Third Street in Little Bangladesh.

“People hear Koreatown, they assume that it means that this is a program or an archive for Korean Americans,” said Katherine Yungmee Kim, director of the storytelling program. “But we are multiethnic. We want to represent the entire community that lives here.”

In the last several years, the teen interviewers have turned their attention to subjects including the garment industry, LGBTQIA life and food culture. As the collection of interviews grew, Kim began thinking about where they would ultimately live.

“I was always worried that we have all of these interviews and they’re just sitting on a hard drive,” she said.

A path toward a more permanent home began to emerge in 2024, when the storytelling program focused on traditional healing.

While researching Zapotec plant medicine, one high schooler came across UCLA’s Archive of Healing, a vast digital collection of knowledge about healing practices from cultures around the world.

Its materials stretch back more than 200 years and include published sources, folkloric fieldnotes and oral histories.

Kim asked UCLA’s David Shorter, a professor of World Arts and Cultures who’s overseen the Archive of Healing since 2012, to serve as an adviser to the project.

At first, the two had an idea to add Koreatown’s traditional healing interviews to the UCLA collection.

Then the idea got bigger.

Kim said she began seeing storytelling itself as a form of healing, especially as people described immigration, war, displacement and other difficult experiences.

The new K-Town Archive features recordings and photos from Koreatown and surrounding communities.

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UCLA Library Digital Collections

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“All of these stories are healing,” she said. “Why are we just narrowly looking at traditional healing modalities?”

The resulting K-Town Archive became the Archive of Healing’s first community-specific sister site. The two databases are connected, meaning material from Koreatown can also surface through searches of the larger Archive of Healing.

“What the K-Town Archive brings is real people’s stories in long form, so it's not just little snippets anymore,” Shorter said. “You actually get to hear a person, know that these are real humans, and talking from a contemporary moment.”

Kim said that it was important to populate the archives with as many voices as possible so visitors encounter more than “one historical perspective.”

The effort to create places for those conversations won’t be confined to the internet.

Lauren Kim in front of her father's apothecary cabinets. Their interviews are now preserved in the K-Town Archive.

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Courtesy of Lauren Kim

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KYCC is also setting up an art and wellness Center at Pico Boulevard and Western Avenue in a building that used to house a Dollar Tree.

Kim said the center will host Koreatown Storytelling Program events as well as arts and healing workshops. Public programming is expected to begin in January.

Lauren Kim’s family continues to stay connected to the storytelling project. She agreed to sit for an oral history of her own, talking about her childhood and connection to Koreatown.

That sparked new conversations within her family and sent them digging through old photographs, including images of her as a child posing in front of her father’s wooden apothecary cabinets.

For Kim, she was honored to contribute to the archive as “an example of what it means to work intergenerationally,” Kim said. “That felt special.”