D.C. Mayor Muriel Bowser’s proposed budget would cut the number of work hours the city will pay for in half for a large number of mental health providers, limiting the services people receiving mental health and community support would have access to.
As proposed, the budget would cut the number of hours D.C. Department of Behavioral Health (DBH) providers can bill for community support from 200 units to 100 units, or from 50 hours to 25 hours per client, per 180 days. Community support services include activities like getting a client to the grocery store, helping them to renew their health insurance, or going to the pharmacy with a client to pick up meds. This job is primarily done by community support workers.
Bowser’s proposed budget change effectively cuts the time these workers can be paid for spending time with clients in half. The change is to not only incentivize clients to use more clinical services, like therapy or psychiatric treatment, instead of community services, according to DBH, but also to make service providers shift towards offering more clinical care.
However, providers and lawmakers worry the proposed policy change will lead to more emergency room visits as care gets delayed, patients use services not designed for someone having a mental health crisis, or don’t receive care at all. Members of the D.C. Council and mental health care providers against the change recommend DBH work with providers to find a different cost-saving measure that won’t affect people’s care. But the Committee on Health’s FY26 budget recommendations report did not recommend giving any money to the agency to revert the changes, so it’s possible the cut in hours is one the council is willing to live with.
Community support workers practice under the supervision of someone with a clinical license and provide direct support to individuals and families dealing with mental health or substance use challenges by helping with medication management, taking clients to appointments, and helping clients navigate the health care system and follow care plans.
John Smith is the CEO of Prestige Healthcare Resources, a DBH-certified health care provider, and has been working in the mental health field in D.C. for 16 years. In his experience, the clients who need a community support worker often need assistance following up with appointments, renewing their insurance, getting a prescription, or sticking to a treatment plan while navigating challenges such as experiencing homelessness. And when they don’t get that help, he said, there’s an uptick in emergency room visits.
According to DBH, mental health care providers are charging the city too much for these non-clinical services. The agency says many providers bill significantly more for community support services than for clinical services, according to a summary of DBH’s argument in the Committee on Health’s FY26 budget recommendations report. DBH attests clients would be better served through spending time with providers doing clinical treatment, such as therapy, counseling, and psychiatry with a licensed professional.
“The Department of Behavioral Health is committed to providing effective treatment services and supports so residents facing mental health disorders can achieve optimal health and live to their full potential,” a DBH spokesperson wrote in a statement to Street Sense. “DBH-certified community-based providers are required to deliver a range of mental health services, including counseling, medication support, community support services, and crisis supports. To support long term recovery, DBH works to make sure that services fit the individual and that no single service becomes one size fits all.”
But Mark LeVota, the executive director of the District of Columbia Behavioral Health Association, a trade association for organizations that provide services for people with mental illness, substance use disorder or both, believes DBH is underestimating the importance of community support workers and overestimating how many clinical staff would be available to fill the gap.
Of the 43,427 people who received services through DBH, 36,823 received community support services while 12,772 received therapy services, according to data from DBH’s latest utilization report for FY23.
It’s an ideological battle between DBH and providers on the importance of wraparound services. While DBH feels a client only needs to be helped so many times with day-to-day tasks before they can handle it themselves, providers believe this patient population needs the extra community support. If someone isn’t there to help get groceries, clients don’t eat, they say. If someone doesn’t get help making appointments, clients don’t see a psychiatrist, and don’t get their medication.
“We are worried that people will not have enough of the care that they need, and that there are not meaningful substitutes,” LeVota told Street Sense. “Even though there are many other clinical services that are available, with the clinical workforce shortage that we have, those just are not available substitutes to the extent that they would be needed.”
The workforce of DBH-certified providers is about 9,000 people, according to a rough estimate from LeVota, who said it’s hard to know the exact number because not all DBH-certified providers are members of the health association. But he estimates that of that 9,000, about 2,000 have some kind of clinical license, such as psychiatrists, advanced practice registered nurses, social workers, or licensed professional counselors. The rest of the 7,000 are unlicensed staff, mostly community support workers. LeVota believes DBH’s push to make providers focus on clinical services at the expense of community support worker hours undermines the understanding that the workers do provide a clinical benefit, because support services are based on a treatment plan designed by a clinically licensed person.
Cutting hours could overtax an already overburdened system that can’t find enough social workers, and it could cost people jobs, providers say. Last fiscal year, the units were cut from 600 to 200, which the council approved because most clients used 200 units or less. Still, Smith estimates last year’s cut from 150 to 50 hours and the lack of a tracking system for clients’ available hours have cost Prestige Healthcare Resources $1 million in services to clients who’ve exceeded their allotted hours. If the cuts continue at the rate they’re going, Smith said, he’ll have to let go of half of his staff.
“We eventually have a financial impact, not just for the company, for the city, right?” Smith said. “We are providing revenue for the city, taxes, right? So basically, we just downsize, let the staff go, then focus on what we can do, what other services we can offer the community.”
In some ways, this is what DBH wants. Prestige Healthcare Resources is focusing on other services besides community support, which the city sees as rightsizing the agency, providers, and the services. If the rhetoric sounds familiar this budget season, that’s because it’s in the tagline for Bowser’s proposed budget: “Growing our economy, rightsizing spending, and investing in our shared priorities.”
The change isn’t yet set in stone. The Committee on Health and its chair, Councilmember Christina Henderson, wants DBH to reconsider the cut because “providers across the network have consistently warned that the 100-unit cap is not operationally feasible and would severely limit access to care,” the committee stated in its FY 26 budget recommendations report. The committee recommends DBH “reconsider the proposed reduction, restore funding to maintain the current 200-unit level, and reengage with stakeholders to develop a clinically appropriate and sustainable model.”
But the choice to cut unit hours ultimately lies with DBH and its director, Barbara Bazaron. And providers are pleading for her to reconsider, despite knowing the city doesn’t have the funds in the budget it did years ago.
“We understand the budget issue, we understand there’s a reduction, all those things,” Smith said about the need to cut costs in the District’s budget somewhere. “But it can be done in a way that is done systematically, that doesn’t really have a major adverse effect. You have to do it a systematic way that doesn’t have a huge economic impact on business owners.”
This article originally appeared in Street Sense’s July 2, 2025 edition.
