State hospitals report IST waitlist declines, propose budget adjustments amid rising outside‑hospital costs
April 30, 2026 | California State Senate, Senate, Legislative, California
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The Department of State Hospitals told a state Senate subcommittee it has sharply reduced the backlog of people found incompetent to stand trial and is projecting modest census growth as counties expand community‑based restoration and diversion.
"During the pandemic in January 2022, we had reached an all‑time high of 1,953 IST individuals on the pending placement list," Director Stephanie Clendenin said. "At the April, we had only 250 individuals on that pending placement list," she added, using those figures to illustrate progress toward court‑ordered deadlines.
Why it matters: the department said meeting the Stiavetti court benchmarks — including initiating treatment within 28 days by March 1, 2025 — remains a central objective, and the pace of county activation of community programs affects both bed use and budget projections.
Clendenin summarized the proposed fiscal‑year 2026–27 budget at about $3.2 billion, a roughly 1% decrease from the 2025 budget act that DSH attributes primarily to projected savings from IST solutions. The department asked for four permanent positions and two limited‑term positions to address dental workload and to implement SB 380 transitional‑housing analysis work.
Committee members pressed DSH on operating costs that are rising faster than expected, including outside hospitalizations and pharmaceuticals. "Some of the cost increase is driven from not only inflation, but we also have an aging population within the state hospitals," Clendenin said, noting patients in long‑term institutional settings present complex medical needs that often require specialty providers or acute hospitalization beyond DSH facilities' scope. DSH reported roughly 18% of its patient population is enrolled in Medicare, which can cover some outside medical care, but enrollment and consent pose administrative challenges.
On IST savings, DSH and Finance officials said updated county ramp‑up timelines for community diversion and restoration programs have produced one‑time and ongoing savings estimates; the administration is reporting one‑time savings in current and budget years but anticipates expenditures will grow as counties fully activate planned programs.
What happens next: the subcommittee held the item open and requested follow‑up data on outside‑hospitalization cost drivers, the remaining IST fund balances and the activation timeline for a new Central California facility expected online in January 2027.
"During the pandemic in January 2022, we had reached an all‑time high of 1,953 IST individuals on the pending placement list," Director Stephanie Clendenin said. "At the April, we had only 250 individuals on that pending placement list," she added, using those figures to illustrate progress toward court‑ordered deadlines.
Why it matters: the department said meeting the Stiavetti court benchmarks — including initiating treatment within 28 days by March 1, 2025 — remains a central objective, and the pace of county activation of community programs affects both bed use and budget projections.
Clendenin summarized the proposed fiscal‑year 2026–27 budget at about $3.2 billion, a roughly 1% decrease from the 2025 budget act that DSH attributes primarily to projected savings from IST solutions. The department asked for four permanent positions and two limited‑term positions to address dental workload and to implement SB 380 transitional‑housing analysis work.
Committee members pressed DSH on operating costs that are rising faster than expected, including outside hospitalizations and pharmaceuticals. "Some of the cost increase is driven from not only inflation, but we also have an aging population within the state hospitals," Clendenin said, noting patients in long‑term institutional settings present complex medical needs that often require specialty providers or acute hospitalization beyond DSH facilities' scope. DSH reported roughly 18% of its patient population is enrolled in Medicare, which can cover some outside medical care, but enrollment and consent pose administrative challenges.
On IST savings, DSH and Finance officials said updated county ramp‑up timelines for community diversion and restoration programs have produced one‑time and ongoing savings estimates; the administration is reporting one‑time savings in current and budget years but anticipates expenditures will grow as counties fully activate planned programs.
What happens next: the subcommittee held the item open and requested follow‑up data on outside‑hospitalization cost drivers, the remaining IST fund balances and the activation timeline for a new Central California facility expected online in January 2027.
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