The Issue

Recent regulations that established new staffing requirements for inpatient psychiatric hospitals have made it harder for Californians in mental health crisis to get care. Prior to the regulations that took effect on June 1, 2026, there was already a shortage of about 2,000 inpatient psychiatric beds for adults and 1,800 for children and adolescents. That’s because long-standing Medicaid funding restrictions and low reimbursement rates have stalled the growth of psychiatric inpatient care to keep up with demand.

Access difficulties aren’t due to hospitals not doing their part: in fact, they are making progress to hire hundreds of newly licensed nurses to comply with the new regulations. But nurses are reporting significant dissatisfaction with tasks previously handled by other positions and are leaving quickly. This turnover is making the target challenging to attain.

For people in crisis, bed closures mean traveling much farther for care, away from families and support systems. Patients also experience prolonged waits in crowded emergency departments. This can limit or delay access for others who need care for heart attacks, injuries, and more.

What’s Needed

Three commonsense, targeted adjustments to the regulations, along with additional funding, can protect access for those in need while maintaining safe, high-quality care.

The state should fulfill the requirements of 2024’s Proposition 35 by allocating Behavioral Health Facility Throughput – Managed Care Organization funds to ensure adequate payment rates are provided for Medi-Cal inpatient psychiatric services. With $600 million available, the Department of Health Care Services should allocate at least $275 million to Medi-Cal inpatient psychiatric services.

Additionally, the following adjustments to the new regulations would help protect access to vital services:

• Implementing a differential staffing ratio overnight, since patients in psychiatric hospitals don’t require the same nursing care as patients in general hospitals and are always monitored.
• Allowing nurses who are on break to still be counted in the ratios as long as there is appropriate coverage for patients. This would recognize that patients who are participating in therapy sessions, recreational activities, family visits, and doctor visits are in a safe, monitored environment.
• Allowing flexibility on the types of professionals who are counted in the staffing ratios. The new regulations allow only licensed nurses to be included in the staff-to-patient ratio, but acute psychiatric hospitals focus on restoring the emotional well-being of patients. This treatment is typically — and appropriately — performed by an entire team of health professionals, including mental health technicians, psychologists, psychiatrists, occupational and recreational therapists, and others.