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.

Democrats' big wins in these midterm elections couldn't have happened without some massive voter shifts.

Young voters, Latinos and Asian Americans, urban and suburban voters, men and independents all moved heavily to the left.

One of the sharpest turns in this election was by Latinos. And Democrats had their best performance with white voters in years

In 2024, President Trump won a record share of Latino votes for a Republican presidential candidate. But they took a sharp left turn in this election after Trump's promises of lower prices never came to fruition and his administration's harsh deportation tactics backfired.

Latinos swung 21 points toward Democratic House candidates, compared to two years ago.

Asian Americans also sharply diverged from 2024, also going 21 points more in Democrats' favor, from a 22-point advantage to a whopping 43.

Democrats even tied with white voters. To put that in perspective, Democrats haven't won white voters in a presidential election since 1964. Since then, they came closest in 1992 and 1996 when former President Bill Clinton lost them by 2 points both times and then in the 2006 midterms when Republicans won them by just 4.

By age, it was a sharp boomerang, particularly with voters 18 to 29

Democrats won this group of young voters by 48 points, a 34-point swing from two years ago.

To put in context just how dramatic of a margin that is — it's wider than for former President Barack Obama in 2008 when he won the youngest voters by 34 points. The difference in 2008 is they were 18% of the electorate, compared to 11% in this midterm.

Young voters traditionally have the biggest turnout drop from presidential to midterm elections of any group, so there are likely many Republican-leaning 18- to 29-year-olds who simply stayed home.

Democrats also won by huge margins with urban and suburban voters

Urban voters swung by 25 points in their favor, while voters in the suburbs, who had voted narrowly for Trump in 2024, went for Democrats by 19 points.

But Democrats can't win in red states without minimizing losses in small towns and rural areas. Democrats lost them by 16 points this year, a 16-point shift in their favor, compared with 2024, when they lost them by 32.

Democrats won men for the first time since 2008

Women were the fuel for Democrats' wins in these elections. They broke by 19 points for Democrats, 13 points wider than in 2024 and the best mark for the party since Trump's first midterm.

But the shift with men was notable. Democrats won men by 2 points, a 16-point shift from 2024 and the first time the party has won men since 2008. It's only the third time in 34 years that Democrats have won men.

The other time was in 1992 when Bill Clinton won them by 3 points, and that was with a third-party candidate in the race, Ross Perot, who won 19% of the national popular vote.

Republicans saw their worst performance with independents since at least 1998

The number to watch heading into Tuesday night for Republicans was 46%. That was the mark they needed with independents in order to do well. When they have hit that threshold in the Trump era, they have done well, winning the presidency in 2016 and 2024 and making gains in the House in 2022.

But when they were below it, they didn't do well, losing more than 40 seats in the House in 2018 and the presidency in 2020.

In these midterms, they didn't even get close. They only won 38% of independents, their worst mark since at least 1998 when independents viewed the impeachment investigation against Clinton as politically motivated and an overreach.

The only other time that comes close was in 2006 when they only won 39% of independents, and Democrats, like this year, won both the House and Senate.

More graphics from the voter poll

Methodology

2026 data comes from a poll of tens of thousands of voters, conducted by the firm SSRS for a number of news outlets, including the Associated Press. The full sample has a margin of error of plus or minus 0.6 percentage points. Data may shift as votes and exit poll analysis are finalized.

2018-2024 data comes from exit polls conducted by Edison Research (now Edison Research at SSRS) for a number of news outlets. NPR accessed all data via results posted by CNN and ABC News.

2026 data combines results from in-person exit poll responses and a pre-election survey of voters, while 2018-2024 data combines results from in-person exit poll responses and responses from early and absentee voters.
Copyright 2026 NPR

Chemical manufacturer 3M will pay up to $7.35 billion to settle lawsuits by people who say they were sickened by groundwater contamination from compounds used in firefighting foam and other consumer products.

The St. Paul, Minnesota-based company announced the settlement Tuesday. It will pay the money over nine years to as many as 120,000 people who say they were harmed by exposure to per- and polyfluoroalkyl substances, known collectively as PFAS. The chemicals contaminated groundwater near military bases, airports and other locations where the foam was used to extinguish fires.

3M did not admit liability for the contamination under the agreement.

Called “forever chemicals” because they don’t degrade naturally in the environment, PFAS have been linked to health problems including liver and immune system damage and some cancers. The chemicals are also used in nonstick, water- and grease-resistant products, including clothing and cookware.

3M chairman William Brown called the settlement a “significant milestone” that substantially reduces uncertainty from the litigation. The company previously reached settlements in other PFAS-related lawsuits, including a $450 million agreement with the state of New Jersey to settle claims of natural resource contamination and a deal to pay more than $10 billion to many U.S. public drinking water systems.

Other manufacturers, including DuPont de Nemours Inc. and spinoffs Chemours Co. and Corteva Inc., have agreed to settlements totaling more than $1 billion to resolve PFAS claims.

Fred Thompson, an attorney with the Motley Rice law firm that helped negotiate the 3M settlement for the plaintiffs, called it welcome news for “the thousands of victims who have sought answers and accountability for nearly a decade.”

He said in a news release that the plaintiffs urgently need help covering mounting medical bills and other costs.

Under the terms of the settlement, the payouts will begin with $50 million this year, followed by yearly payments of more than $1 billion each year from 2028 to 2033.

3M could make additional payments if enough plaintiffs participate. If too few sign on, 3M has the option to cancel the settlement and continue fighting the lawsuit.

Environmental activists say PFAS manufacturers knew about the chemicals’ health risks long before they became public. They noted that the same attributes that make the chemicals so valuable in many uses — resistance to breakdown — also make them hazardous to people.

The Environmental Protection Agency has set strict limits on PFAS in drinking water from public utilities and requires testing, but those rules do not apply to private wells.

A study that would help federal regulators understand which industries dump the forever chemicals with their wastewater has been stalled for two years, awaiting review by the White House Office of Management and Budget.

Longer wait times for graffiti removal and streetlight repair. Fewer police officers per shift. Completely eliminating school crossing guards.

Those are just some of the service cuts the city of South Gate made earlier this year as it stared down a $9.4 million annual budget deficit and a looming fiscal emergency.

But none of that was enough to convince South Gate voters to approve an 8% utility user tax that would have been tacked onto a wide range of utility bills, including electricity, water, cable and phone service. Now, the city is gearing up for more cuts, including closing sports fields and the city pool for the winter months.

South Gate’s utility tax was just one of the many ways Southern California cities asked their residents to give them more money via local tax initiatives this November, with proposed taxes on everything from hotel stays to cannabis businesses.

And those early results suggest South Gate is an outlier: Of the 32 total local tax measures on the ballot in Los Angeles and Orange counties, all but six appear poised to pass, according to early results. (There are still several more days of vote counting to come.)

Eleven transient occupancy tax measures, which tax overnight stays in hotels or short-term rentals, passed in cities from Burbank to Los Alamitos. Most cities sought to increase their existing hotel taxes by anywhere from 1 to 5 percentage points, while Lynwood residents voted to establish a hotel tax for the first time.

Business-related taxes, such as taxes on business licenses or on certain businesses, also mostly passed, as did most parcel taxes in cities including Pasadena and Culver City.

But sales taxes saw more mixed results. Cudahy, San Gabriel, Orange, Santa Ana and Los Angeles all approved sales tax measures, while voters in Diamond Bar, Hermosa Beach and San Clemente all voted down their local sales tax proposals.

Most of those sales taxes focused on maintaining basic city services in communities facing big budget deficits, driven by the rising costs of insurance, maintenance and infrastructure projects, and employee pensions, among other factors. But in San Clemente, the proposed 1% sales tax would have specifically funded sand replenishment and other beach projects, along with wildfire prevention work. That measure appeared to be headed for failure, with just 36% of voters in support as of Wednesday afternoon.

Voters in San Marino approved an extension of their utility tax, and increased it from 5% to 6%. Last year, the tax provided almost $2.2 million in revenue.

City officials in South Gate had hoped for a similar boon, and projected the utility tax would bring in an estimated $10.4 million per year in general fund revenue, while raising total utility costs by about $39 per month for a typical household.

Leading up to the election, the city of South Gate pointed to other neighboring cities that have their own utility taxes, including Downey, Lakewood and Norwalk, where the tax mostly hovers around 5%. “South Gate is the exception, not the rule,” noted one city presentation that pointed to these other taxes in a bid to coax voters to go along.

Voters weren’t convinced. “I’m extremely frustrated that you now want to do electricity, water, sewer, cable, cell phone, gas. ... That hurts us. You’re passing that on to us and that is absolutely not acceptable,” said one resident at a City Council meeting on the measure earlier this year.

LAist has reached out to the city of South Gate about what’s next for the city.

The city of West Hollywood has approved an ordinance to create a domestic partnership registry for people in polyamorous relationships.

The domestic partnership registry extends certain legal protections for people in the city, including visitation rights to hospitals and jails in West Hollywood and some tenant protections. The registry doesn’t replace the state’s marriage or the state’s domestic partnership laws.

“It's a landmark ordinance and really puts and continues to elevate West Hollywood as a city that is here to support queer people and queer families as they evolve in their needs,” said Chelsea Byers, a West Hollywood City Council member. “I think that's a real joy that we can bring to people — that they can live in a greater sense of being seen and understood.”

How it works

To file, people in a multi-partner relationship will submit a form in person that will be provided by the City Clerk’s office — all members of the relationship will have to provide identification to the clerk.

The ordinance also offers an option by mail, if the signatures are notarized.

The ordinance builds on historical precedent

In 1985, the city became the first city in the nation to create a similar domestic partnership registry for same-sex couples. Similar to that registry, people outside the city can also register.

“This new law not only gives polyamorous unions legal recognition, it also gives people permission to imagine a future together and to plan their lives openly,” said Christina Fialho, president and founder of Rewrite the BiLine, an advocacy group for bisexual people and nonnuclear families, who advocated for the ordinance.

Several cities in Massachusetts have also passed multipartner domestic partnership laws.