Speaker numbers apply only to this recording.
On Friday, October 2, 2026, at 9:32 AM, At-Large Councilmember Christina Henderson convened a public oversight roundtable in Room 123 of the John A. Wilson Building to examine the Department of Behavioral Health's (DBH) fiscal year 2026 budget pressures and their effects on residents, providers, and staff. The meeting lasted until 11:06 AM. DBH Director Dr. Barbara J. Bazron, agency fiscal officer Adrian Reid, interim COO Melvin Barry, and St. Elizabeth's Hospital CEO appeared to testify and answer questions.
FY26 Budget Pressure Overview: Dr. Bazron testified that DBH faced a $20.6 million budget pressure by the end of FY26. The primary drivers were a disproportionate use of community support services and higher-than-anticipated recovery support services. The Q1 Financial Review Process (FRP) initially projected a $33 million deficit, which was later reduced by $8.8 million in collective bargaining agreement (CBA) costs that were resolved through the workforce investment account. The narrative of the Q1 FRP had omitted the CBA, causing confusion. The Q3 FRP erroneously stated $16 million would be absorbed from the opioid abatement fund, but the correct amount was $5.7 million, which was ultimately not used.
Fraud and Oversight: Dr. Bazron detailed actions taken, including a hiring freeze (excluding direct care and critical positions), personally approving non-personnel spending, and increasing oversight. As of the hearing, DBH had 12 providers under investigation by the Medicaid Fraud Control Unit, three pending decertifications, four voluntary closures (two under investigation), and three cases at the Office of Administrative Hearings. Councilmember Henderson pressed on the timeline of fraud detection and action, noting that fraudulent billing had been flagged as early as February 2026.
Community Support Services Reduction: Effective late November 2026, DBH will reduce automatic authorization of community support services from 200 units per 180 days (2 hours per week) to 100 units per 100 days (about 1 hour per week), with an additional 50 supplemental units available with approval tied to a DLA-20 functional assessment. The policy was not yet finalized, causing frustration among providers who learned of the change after the budget was submitted to the Council. Dr. Bazron argued that most consumers receive about 105 units on average, and the reduction aligns with the service's original purpose as a non-clinical support.
Recovery Support Services: Expenditures rose from $2.7 million in FY24 to $21.4 million in FY25—an increase the agency described as 88%, though the precise percentage was not clarified. There was a significant increase in the number of people served, but the average service was about 3.5 hours. The state plan amendment currently has no limits on recovery support, and DBH is working with DHCF to address that.
Vacancies and Staffing: DBH has a 20% vacancy rate. Of the 57 mental health providers (out of 74 total providers), oversight is conducted by 25 staff across provider relations (5 staff), certification (9 staff), and data/performance management (11 staff). Vacancies are concentrated in administrative roles, not in grants management. St. Elizabeth's Hospital has approximately 80 vacancies (primarily nursing), with a current average daily census of 270+ patients, mostly forensic.
St. Elizabeth's Hospital Updates: CEO reported that a $6 million HVAC and fire safety upgrade project has begun and will take 18–24 months. Patient transport for off-site dental and specialty services is being finalized; dental will be provided via off-site appointments for all 270+ patients twice a year. Ten additional security staff positions have been created and recruitment is starting. The Councilmember acknowledged that past security concerns had been raised by the hospital but not transmitted to the Council due to the budget process.
All right. Good morning. Good morning. I'm at large Councilmember Christina Henderson. I'm calling this public oversight round table to order. Today is Friday, October 2nd, 2026. We are in room 123 of the John A. Wilson building. The time is 932 AM. Today we are here to examine the Department of Behavioral Health's uh fiscal year twenty twenty six budget pressures and the effects on residents providers and staff. I recognize that today is October 2nd, and so we are officially in FY27, but I think it is important for us to examine some of the things that happen in FY26 so that we can go forward and hopefully make some changes. Um I believe at last account uh the Department of Behavioral Health would have ended FY twenty-six with a a twenty point six million dollar budget pressure. So we want to look at what drove those, how they were resolved or attempted to be resolved, and whether the department's FY27 funding can sustain necessary services. Do you have slides or that was somebody else? Okay, you're good. Okay. Sorry, that was DC Health earlier. Okay. Uh good morning, Chairperson Henderson, council members and staff. I am Dr. Barbara J. Basron, Director of the Department of Behavioral Health. With me today are Adrian Reid, our agency fiscal officer, and Melvin Barry, interim chief operating officer. I am here today to testify on the financial challenges in the department of behavioral health's fiscal year twenty twenty-six budget and our steps taken to address them. Under the leadership of Mayor Bowser and the guidance of Mayor uh Deputy Mayor Wayne Turnich, DBH supports healthier and stronger communities by working to prevent the onset of mental illness and substance use disorders and providing a range of community-based treatment services and recovery support services primarily through DBH certified providers. Okay. DBH provides crisis services, operates adult and child urgent care clinics, and manages St. Elizabeth's Hospital for those who require inpatient care. As the State's behavioral health authority, we also are responsible for addressing the behavioral health of all district residents. Despite the budget challenges that we will discuss today, DBH makes available a full range of treatment services for residents of all ages by phone, at home, in school, or in the community. I would now like to address the challenges in our fiscal year 2026 budget. Our third quarter financial report projects a $2.6 million spending pressure. Early in the fiscal year to address the spending pressures, DBH instituted an agency-wide freeze on hiring, except for direct care positions primarily at St. Elizabeth's Hospital for operational positions considered critical to implement the agency's mission. Decisions on new hires or backfills are made on a case-by-case basis. The current vacancy rate is 20 percent, which is usually kind of ranges between 10 and 15 percent. I also worked closely with our agency fiscal officer to set up a system to personally approve and prioritize spending for all nonpersonnel services. These steps were not sufficient to address the spending pressure, as the drivers of the budget pressures are disproportionate use of community support services and a higher than anticipated use of recovery support services. We are projecting a total local match expenditure of $66.6 million, while our budget is 45.6 million. We are working with the agency fiscal officer and the mayor's budget office to resolve the projected deficit for FY26. According to our projections, if the use of community-based support services remains at the same pace, we will face a spending pressure in our FY27 budget. We are taking steps now to contain costs. We will reduce the automatic authorization of community support services to 100 units per 100 days, which is about one hour per week, and allow providers to receive authorization for an additional 50 supplemental units based upon consumer needs. We are having conversations with the providers now and will hold consumer forums to discuss this change and the array of clinical services available. We have stepped up monitoring of substance use disorder recovery support services, which has led to the closure of one provider and a pending decertification of another. In addition, we intend to maintain the freeze on hiring and non-personnel service expenditures that are not mission critical while closely monitoring expenditures. During our FY25 performance oversight hearing in February, I testified about the major challenges facing DBH and our progress in addressing them.