I talked for an hour with Ana Booker, recently appointed to the Behavioral Health Board by Supervisor James Gore. She has attended a past meetings of the Board, though has missed the past two meetings while traveling. “I can’t believe they haven’t spent more time talking to themselves about their perceptions of Health Department program conditions.” said Booker, who serves as Outreach Manager for West County Community Services. “I’m learning as quickly and thoroughly as I can about why it is so hard for our clients to obtain services and housing”. Booker also serves as a Navigator within InRESPONSE, Santa Rosa’s mobile crisis support program, funded by the County Department of Health Services through Measure O funding.
Author: Gregory Fearon
Two Gifts from the Board of Supervisors: A Moonshot and New Health Officer
This morning, the Sonoma County Board of Supervisors gave the Department of Health Services Director (Nolan Sullivan) two gifts. The first was the appointment, starting tomorrow, of Mia Shim, MD, MPH as the new Sonoma County Health Officer. Dr. Shim served recently as interim health officer and chief medical officer for Public Health in Seattle, Kings County, Washington, one of the largest local public health systems in the country – serving 2.3 million residents. More on her career can be found here.
The second gift was what Nolan described as “a moonshot, and probably a career-defining project”. Authorizing the termination of a decade-old effort to utilize $40 million in State funding to build a 72-bed facility for mental health treatment and recovery of jail inmates, and the redirection of $27 million in local match funding and up to $9 million in Opioid Settlement funding, the Board approved the acceptance of a new $54 million State grant to build two 16-bed Mental Health Recovery Centers and fifty-six Substance Disorder beds on either or both of the current Orenda Center Detox site and Los Guillicos properties in Eastern Santa Rosa. Read more on a previous HEAPA post.
The Board voted to give permission to the Department to fast-track a community Request for Design-Build Proposals in the two months to see if the remaining gap in projected costs can be cut to what might possibly be funded from every other County and regionally-contracted source imaginable. “If we fail, we’ll continue to pay an enormous amount of money to send our residents to distant private facilities far from their families”, said Director Sullivan.
HEAPA Responding to Homeless Power and Food Emergencies
Those without system power are vulnerable when medical and food requirements demand life-sustaining equipment. And when power outages, of whatever duration, cease the operation of refrigeration, body-support, and mobility devices, it is critically important. HEAPA has purchased some multi-use, portable power batteries which will be targeted to homes and encampments which it will identify as critical locations to support the provision of food and medical support to homeless and at risk of homeless in our community. Our efforts should be directed toward those with the least amount of power to meet basic needs.
County Behavioral Health Facilities in Trouble
As you might have read in the PD this morning, the grant awarded to the County last year to build additional locked beds for seriously mentally ill residents may be returned to the State. On Tuesday, The Department of Health Services is requesting guidance from the Board on whether to move ahead with the original grant to build 64 Mental Health Treatment Center locked beds and 40 Substance Use Disorder Treatment beds using $67 million from the State and $61 million in local funding or one of two alternate proposals suggested by the Department. One would cut the locked facility in half and expand the SUD by 16 beds with $13 million less state funds and $12 million less in local funding. The other would decline the state grant and both facilities.
Local funding being suggested includes repurposing a $40 million grant received in 2015 to build a 72-bed facility for mental health treatment and rehabilitation of inmates. The Department reports that construction and operation costs have exceeded the original award, and the Behavioral Health Housing Unit Project is no longer feasible. Additionally, $3.8 million in Opioid Settlement funding is being suggested.
The Board of Supervisors discussion will occur at their afternoon session beginning at 1:30pm on Tuesday.
Sonoma County Behavioral Health Board Meeting
The Sonoma County Behaviorl Health Board held its monthly meeting on June 16th from 5-7pm at 1440 Neotomas Ave, It was a detailed discussion regarding the Substance Use Disorder (SUD) referral process and the inefficiencies of the current access line. A key takeaway was the recommendation to send individuals directly to treatment facilities rather than the central access line to avoid delays and potential relapses. The conversation also touched on the impact of Measure O and opioid settlement funds in Sonoma County, emphasizing the community’s commitment to improving mental health and addiction services.
Legislative and Budget Updates
Mobile Crisis Mandate: The latest State budget revision suggests the mandated mobile crisis response will be preserved, potentially providing state Medi-Cal reimbursement. Measure O Oversight board sent a formal letter to the Board of Supervisors advocating for full funding of the CAPE teams. Subsequently, the Board of Supervisors voted to restore all five CAPE (school-based) teams, and fully staff the Crisis Stabilization Unit (CSU). CAPE teams provide mobile crisis intervention, assessment, and drug counseling directly in high schools in Santa Rosa and satellite areas. discussed was a strategy to transition CAPE to a mandated service category to protect it from future budget cuts. Additionally, the Department announced that efforts are underway to opt into the IMD (Institute for Mental Disease) waiver by August 1st in order to receive Medi-Cal reimbursement for short-term hospital stays (18-65 age group).
Substance Use Disorder (SUD) Expansion
Recovery Housing: Buckelew was awarded $3.8M for 60-69 sober living beds; project includes unique support for men with children. Youth Services: the Department (DHS) is opening a new facility near Los Guilicos (Valley of the Moon) to provide adolescent residential treatment, withdrawal management, and outpatient care (completion July 1st; licensing 12-18 months).
Tribal Partnerships: DHS executed a MOU with Sonoma County Indian Health Project for traditional healing practices (music therapy, drum circles, herbal remedies). New Outpatient Providers: Paramita, Cura Vita, and Sion have launched or are expanding services; West County Health Centers starting drug treatment in the Russian River area.
Access Strategy: Encouraging direct entry at provider sites rather than going through the central county access line to prevent delays and relapses. Mental Health Integration: Organized Delivery System (ODS) requires licensed practitioners (LCSW/LMFT) to sign off on SUD assessments, forcing better integration.
Probation and Courts: DHS is implementing medical necessity-driven treatment recommendations in court settings rather than arbitrary 9-month sentences.
Behavioral Health Connect: New mandates for evidence-based practices (IPS for employment, Clubhouse services) launching in October.
Stay tuned: HEAPA will publish a link to the video recording of the meeting.
What I learned from the Monthly Behavioral Health Board Meeting
For at least a year, I have been asking that the Behavioral Health Board be given information on the status of the development of program services for those with substance use disorders. With the termination of our county’s ability to claim Medi-CAL reimbursement for such services at least a decade ago, many have been eager to hear what programs we have begun within the resurrection of Organized Drug Medi-Cal Delivery Systems, officially inaugurated almost a year ago.
So when I read in the agenda released last week that Will Gayowski, Sonoma County Department of Health Services Deputy Division Director for Substance Use Disorder Programs, would be giving a presentation to the Board at last night’s monthly meeting, I made sure that it was on my calendar.
I was not disappointed by what I heard. His 45-minute slide show and responsiveness to Board questions was excellent, and I left with a much richer understanding of the work that has been and is being accomplished. More importantly, I came away with a much clearer view of the understanding of the eligibility parameters surrounding the delivery of program services. My perception that SUD services were as narrowly-focused as county-delivered mental health services was wrong, and the insight that provided me has re-charged my optomism about building a more comprehensive integration of services for unhoused individuals in the County.
Will’s presentation contained three key revelations: 1) Access to client assessments is greatly more available, and opportunities to reduce the confusion and duplication are being recommended; 2) those eligible for services need not be as severly-impacted as needed for mental health services; and 3) services are more easily reimbursed by Medi-CAL.
Concentrating on the more recent awards from Measure O and Opioid Settlement funding, Will’s slideshow walked the Board through the variety of agencies, programs, and services which are appearing for our clients. Jan Cobaleda-Kegler, Behavioral Health Directors, augmented his presentation by detailing the Department’s plans for the uses of Measure O and Realignment funding to implement programs for youth, and to address racial and geographic inequities in service delivery. Both she and Will provided new perspectives on the reasoning why the County’s current misalignment in its use of Measure O funding (favoring the buckets funding mental health and not substance use disorder). I’m going to recommend that the slide show and video recording of the meeting be shared with the Sonoma County Homeless Coalition, and the Measure O Oversight Citizens Committee as soon as possible to improve their understanding of substance use disorder program service expansion in our County.
California Transparency Project (CTP) Explained
HEAPA believes that a democracy’s strength comes when local citizens are able to participate in the operation of local government. Not only does such involvement result in widespread understanding of community needs, but increases the capacity of the community to monitor and evaluate the performance of proposed civic solutions. Too often, however, planning processes fail to include those who have experienced the needs being addressed. Instead, participants consist only of those with the time and resources to attend required civic meetings, but with little direct understanding.
HEAPA has a history of providing resources and management support to community programs which have been proposed by nonprofit organizations run by low-income residents themselves. We have witnessed the development of strong solutions to community problems held accountable by knowledgeable consumers. Our partnership grants have also resulted in some of the most empowered community leaders who not long ago were fragile, dependent, and dis-engaged residents.
At the same time, local governments have begun to recognize the value and importance of responding to client and resident “Not about us, without us” movements by adopting “Lived Experience Advisory Planning (LEAP)” Boards to assist in their decision-making processes.
When California voters passed Proposition One, it charged counties with the transformation of several major health service programs through an expanded stakeholder-engaged planning process. Sonoma County, already beginning to merge a community-driven, LEAP Board-advised Homeless Coalition into its Department of Health Services, partnered with HEAPA to support the needed expenses and accommodations of homeless clients to attend and participate in the planning process. For the first time, the voices and first-hand experiences of homeless residents informed a three-year, $800 million plan.
It’s just a start, and all would admit it could have been more robustly implemented, but we’re committed to expanding its application. In its California Transparency Project, which is equipping and training homeless activists to accept and fulfill appointments to city, county, and state government advisory committees, we will continue our empowerment of a pool of invaluable citizens, and strengthening our local democracy in the process.
Treating Homelessness as a Public Health Crisis
HOMELESSNESS
S.F. Chronicle: San Francisco faces a budget crisis. Its homelessness fund is flush with cash
By Maggie Angst [5-27-26] // The Our City, Our Home Fund — financed by a voter-approved tax on large businesses — has exceeded forecasts and is expected to bring in more than $900 million over the next two years.
By Andrew Khouri & Doug Smith [5-19-26] // Reality TV figure Spencer Pratt is jolting L.A.’s mayoral race with vows to clear encampments through arrests and mandatory treatment, rejecting the city’s largely voluntary approach embraced by Karen Bass and Nithya Raman.
By Aaron Schrank [5-27-26] // Findings released Wednesday by Hollywood 4WRD…found in May that more people were living in tents and fewer in cars than RAND had observed in January, a surprising reversal of the recent overall trend.
Los Angeles Daily News: LA Council adds new anti-camping zones in San Fernando Valley
[5-19-26] // The Los Angeles City Council on Tuesday added more anti-camping zones around parks, underpasses, streets and other areas in the San Fernando Valley.
May Sonoma County Homeless Coalition Board Meeting
HR1 and Medical Health Coverage Impacts
CMSP Eligibility & Coverage Reductions: The Coalition heard from the County Administrator’s Office that CMSP recently voted to reduce eligibility and service levels to control costs as more individuals fall off Medi-Cal. No coverage for behavioral health, mental health, or dental. Worst-case scenario estimates up to 11,500 residents would fall off Medi-Cal and could qualify for CMSP. Fiscal Year Impact: County expected to be charged $700k–$800k for participation; insurance coverage charges likely deferred until year two. Medi-Cal Work Requirements: Rolling impact starting January 1, 2027 based on individual renewal dates. “Truly Indigent” Population: Life and limb emergency care remains a county obligation; community clinics have requested $12.8M to meet this requirement.
The Department of Human Services reported on CalFresh & Food Security Work Requirements. Effective June 1, 2026, there is a discrepancy between CalFresh and Medi-Cal rules creating administrative hurdles and resident confusion. Risk: 4,700 to 5,000 residents subject to new work requirements are at risk of losing benefits. Mitigation: A “Food Convening” event is scheduled for June 19 to coordinate with nonprofits and food banks regarding expected system strain.
County Mitigation Strategies & Staffing
The Department continued on to indicate that they have submitted a Three-Year Funding Request asking the Board for $23.8M in one-time general funds for short-term mitigation rather than permanent cuts. New Positions (Pending Board Approval): 38 Eligibility Workers to manage doubled workload from semi-annual renewals. 7 Caseworkers to help residents navigate work requirements and volunteer placements. Outreach Efforts: Mobile services vans and social media campaigns are active, though board members expressed concern that many residents remain unaware of changes.
Behavioral Health Services Act (BHSA)
The Sonoma County Homeless Coalition (COC Board) heard a discussion on the Behavioral Health Services Act plan on the transition from MHSA: Part of Prop 1, the Plan attempts to report on the expenditure of $261-286 million each year for the next three years. one of the new requirements is the expenditure of a $10M bucket for housing and homelessness. Key Updates: Funds target the seriously mentally ill and those with severe substance use disorders. Majority of services and housing referred through Coordinated Entry (CE) and tracked in HMIS. Includes funding for prevention and transitional rents through CalAim. Timeline: The Board of Supervisors will review the integrated plan on June 2, 2026. The Plan highlighted the inclusion of ‘lived experience’ gathered from focus groups in Sonoma Valley and West County. Several Coalition members and the public expressed concern that the Coalition was not fully engaged in the development of the Plan. The board encouraged attendees to participate in the upcoming Board of Supervisors meeting on June 2nd to address these meaty topics before the June deadline.
Lived Experience Board (LEAP) Updates
Presentations: The LEAP board reported that it was selected to present at the Lived Experience Conference in September, and is applying for the Threads conference. State Level: A LEAP board member was recently appointed to the California ICH Lived Experience Board. They also reported that high gas prices are significantly impacting the unhoused and low-income residents, hindering their ability to meet new work requirements or maintain safety.
Lead Agency Operational Updates
Nolan Sullivan (DHS Director) and Hunter (Deputy Division Director) are officially onboarding the homeless team. MRG Report Implementation: Hunter is tasked with operationalizing the MRG strategic plan; full report available to board members. Lead Agency Evaluation: Susan Price (MRG Consultant) will assist the evaluation subcommittee as an independent evaluator; next meeting scheduled for June 18th.
Proposed Governance Model: Exploring a separate commission or JPA for elected officials to separate high-level governance from technical COC operations.
Departmental Merging: Merging homelessness and behavioral health divisions; relocating staff to the Lakes behavioral health campus. Facility Projects:
Arrowwood Shelter: Behavioral health-based shelter launched March 2025. Mickey Zane: Requires major infrastructure repairs (fire risers, sewer). The Department reported that their largest project is a locked Mental Health Recovery Center, funded by a grant from Prop one for $67M. It funded four 16-bed facilities; project on life support as costs ballooned to $120M due to seismic/infrastructure requirements.
Legislative and Funding Challenges
SB 43 Impacts: Law change expanding conservatorship population causing significant cost burdens (100% county funded). Prop 1/BHSA Transition: Shift from Mental Health Services Act to Behavioral Health Services Act effective July 1st results in $10M gain for housing but $15M loss for behavioral health services. Mobile Crisis Funding: Systems in Santa Rosa, Petaluma, and Rohnert Park facing budget crashes due to state Medi-Cal cuts.
NOFA Update
Local NOFA contracts finalized with an average 13% reduction; currently being executed. COC Program FY2026 Renewal Scores: Eight projects evaluated; all scored above 80% of the top project (78/100). Highest Score: CSN Sponsor-Based Rental Assistance (78). Lowest Score: Mill Street Supportive Housing (69.5). Corrective Action Status: St. Vincent de Paul and CSN (Stony Point) remain on corrective action plans but are in 100% compliance. Funding Outlook: 30% cuts expected for permanent housing in the upcoming national NOFO (expected in two days). Reallocation Issues: Buckaloo project reallocation to HMIS software and COTS is currently complicated by congressional automatic renewal mandates.
Homeless Emergency Assistance Program Association 