The traditional government financing design is being turned upside down. No longer can we expect the federal or state governments to advance or reimburse local governments. And if the uses of federal and state funds are now to give tax breaks to the rich, and to end and reduce deficit spending, then federalism and state solvency are going to be severely tested.
Which brings us to the question addressed at Santa Rosa’s goal-setting workshop yesterday – What are the basic services which should consume the City’s budget? What do our residents want, and what should our elected representatives provide, from the City? The Council chose to recognize that its own workforce was exhausted and could not perform well on most of its assigned goals and duties. Their answers were fewer goals, clearly understood by the public, with longer acknowledged timeframes. Their very top priority was to “Achieve and Maintain Fiscal Sustainability”. Though you might have heard that before in tough economic times, I’ve never seen a more worried group of leaders and staff. The word “transformation” was used many times, and I don’t think many had clear visions of positive outcomes.
In the general questioning of the purposes of all government, this local examination is crucial. To many, it may be the only chance for citizen impact. Lately, Sonoma County voters have agreed to tax themselves to provide some vital resources under local control. A unified and cooperative group of leaders could work together to develop a better funding system. The County and its cities need to protect each other from simplistic departmental budget slashing, or none of us will be happy with how local governments will be transformed.
On Tuesday (tomorrow), the Board of Supervisors will be acting on two Consent Agenda items which have the ability to expand service and housing for residents served by the County:
(Item #9) Bond Behavioral Health Continuum Infrastructure Program Round-1 Grant Application Resolution Update. Adopt a Resolution to replace Resolution 24-0519 authorizing the Director of Health Services, or designee, to apply to the California Department of Health Care Services’ Behavioral Health Continuum Infrastructure Program Round 1 (BHCIP 2024) Launch Ready Program Request for Applications, increasing the application amount by $10,202,227.50 for a new not-to-exceed amount of $67,702,227.50 for the construction of four Mental Health Rehabilitation Centers and one Adult Residential Substance Use Disorder Treatment Facility.
(Item #11) New positions to support California Advancing and Innovating Medi-Cal (CalAIM). A) Adopt a Resolution amending the Sheriff’s Office Department Allocation List to add 1.0 Full Time Equivalent (FTE) Administrative Aide, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative. B) Adopt a Resolution amending the Department of Health Services Department Allocation List to add 2.0 Full Time Equivalent (FTE) Senior Client Support Specialists, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative.
In 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release with the goal of addressing the unique and considerable health care needs of justice-involved individuals, improving health outcomes, delivering care more efficiently, and advancing health equity across the state.
Through a federal Medicaid 1115 demonstration waiver approved by the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) has partnered with state agencies, counties, and community-based organizations to establish an expanded system for providing enhanced care. Implementation of the mandated expansion in services, called California Advancing and Innovating Medi-Cal, or CalAIM, involves establishing a reentry process that provides incarcerated adults with the physical and mental health services they need before release, and connecting them to appropriate service providers for care upon reentry to the community.
Eligible inmates will receive services up to 90 days before their release to stabilize their behavioral health conditions and establish a plan for their community-based care. The Sheriff’s Office intends to go-live with the provision of enhanced services in January 2026. The deadline to go live is September 30, 2026.
On Wednesday, there are three meetings that are central to the work of providing direction to County and community services for homeless, mentally-ill, and addicted residents in Sonoma County.
Behavioral Health Board Executive Committee, 10:30am, 2227 Challenger Way, Room 201. Planning meeting for the Full BHB meeting on Feb 18th.
MHSA Program Steering Committee, 1-3pm, 2227 Challenger Way, Galaxy Room (next to Room 201)
Measure O Oversight Committee, 4-5:30pm, 1450 Neotomas Ave, Suite 200. Quarterly meeting to review finances and progress on programs funded.
On January 28th, the Santa Rosa City Council considered, and then delayed approval of a an application to the State of California Department of Housing and Community Development’s HomeKey+ Grant Program for the City to be a co-applicant with Burbank Housing Development and Caritas Homes Phase II LLC in an amount not to exceed $13.95 million. The grant is for the development of permanent supportive housing for individuals or households with an individual who is homeless, chronically homeless, or at risk of homelessness and who are also living with a behavioral health challenge. Caritas Homes Phase II, the final stage of the Caritas Village project located in downtown Santa Rosa will add 30 new affordable apartments reserved for homeless individuals referred through the Sonoma County Coordinated Entry system, meets the eligibility criteria for HomeKey+ funding. The item was pulled from the City Council agenda, and will be rescheduled at a later date.
Last October, the County told our Oversight Board it had plans to spend $44 million this fiscal year, and $46 million in the next one. They were responding to pressure from many to exhaust the tax-fed five buckets, and fund balances, of money that the voters have been contributing since November of 2020. The latest financial report (as of 1/24/25) distributed to us for our February 5th meeting indicates the County has spent $18 million of $19 million available in the second largest bucket (Behavioral Health Facilities) primarily by: 1) building and operating a 16-bed psychiatric health facility (Crestwood) at Los Guillicos, one of only nine in the state; and 2) contracting with 18 long-term residential care facilities in and out of Sonoma County. Of the largest bucket of money ($38.5 million for Emergency Psychiatric/Crisis Services), about two-thirds have been spent ($$25.8 million). Of the third largest bucket (Mental Health and Substance Use Disorder Outpatient Services), only $350,000 of the $15.8 million has been spent. In the second smallest bucket (Behavioral Health Homeless/Care Coordination), $8 million of the $12 million available has been spent. And in the smallest bucket (Transitional and Permanent Supportive Housing), $1 million of the $1.6 million has been spent. As a result, the total fund balance for all of the buckets is down by only $1.8 million, instead of the $11 million drop we had planned to spend. Do we still feel confident we can catch up in the next five months? And what about our plans to lower it by another $14 million next year?
Among the New Year’s obligations mandated by the voters of California are the requirements placed on counties to transform its planning and delivery of mental health and substance use disorder services. New expectations are in place to conduct countywide research involving a wide range of stakeholders to develop integrated global spending plans for the use of all county revenues.
Bringing together dozens of individual program efforts, authorized and monitored from many different state and federal initiatives stretching back many decades, this new Behavioral Health Services Act (Behavioral Health Transformation) reforms behavioral health funding to prioritize services for people of all ages with the most significant mental health needs while adding the treatment of substance use disorder (SUD), expending housing interventions, and increasing the behavioral health workforce. It also enhances oversight, transparency, and accountability at the state and local levels.
The Behavioral Health Services Act builds on many strategies to meet community needs for culturally responsive services that improve health and reduce health disparities for all, including:
Reducing the silos for planning and service delivery.
Requiring stratified data and strategies for reducing health disparities in planning, services, and outcomes.
Advancing community-defined practices as a key strategy for reducing health disparities and increasing diverse community representation.
Sonoma County, through its Department of Health Services, will develop a Three-Year Integrated Plan, which must be developed in partnership with local stakeholders through a process that incudes meaningful stakeholder involvement in mental health and substance use disorder policy, program planning, and implementation, monitoring, workforce, quality improvement, health equity, evaluation, and budget allocations. Integrated Plans will include a demonstration of how the County will utilize various funds for behavioral health services to deliver high-quality, culturally responsive, and timely care along the continuum of services in the least restrictive setting from prevention and wellness in schools and other settings to community-based outpatient care, residential care, crisis care, acute care, and housing services and supports.
Three Local Funding Categories
Local behavioral health agencies are required to develop detailed plans for the use of BHSA funds in each of the following components, then submit those plans to the Behavioral Health Services Oversight and Accountability Commission (BHSOAC), and the CA Department of health Care Services (DHCS) for approval.
Housing Interventions
30% of local BHSA funding shall be dedicated to housing interventions for people living with serious mental illness/serious emotional disturbance and/or substance use disorder who are experiencing homelessness.
Funding can be used for thee full spectrum of housing services and supports, rental subsidies, operating subsidies, and non-federal share for Medi-Cal covered services, including clinically-enriched housing. Zit can also be used to further the California BHCONNECT.
Funding may also be used for capital development projects, subject to DHCS limits.
Full Service Partnerships
35% of the local assistance for Full Partnership (FSP) which should be optimized to leverage Medicaid as much as possible. FSPs include comprehensive and intensive care for people at any age with the most complex needs (also known as the “whatever it takes” model).
Behavioral Health Services and Supports (non-FSP) and Additional Components
35% for other services including Behavioral Health Services and Supports (non-FSP), Outreach & Engagement, Prevention and Early Intervention*, Capital Facilities and Technological Needs, Workforce Education and Training, and prudent reserve.
* A county shall utilize at least 51percent of Behavioral Health Services and Supports funding for early intervention programs and of that 51 percent, 51 percent must be allocated for early intervention programs to serve individuals who are 25 year of age and younger.
I attended the all-day meeting of the Board of Supervisors and Department Directors on Friday at the Sebastopol Vets Bldg. The biggest single set of conclusions is that the BOS is preparing fo the Trump administration to: 1) deport residents, which may cause a reduction in the use of (and payment for) County services by those who fear that programs will share their information with ICE; 2) reduce funding for many local programs serving all of our residents; 3) deny reimbursement for much of the Covid19 service delivery undertaken by the County through DEMA; 4) reexamine the pace of the allocation of any local revenues and reserve funds in anticipation of their need to respond to the conditions described above.
It was clear that most in the room were encouraging the Board to both proceed with its generally progressive moral and fiscal agenda for the next year, and also be prepared to use its revenues and talents to prepare for the chaos and abandonment represented by the intentions of the Trump Administration.
There is a Dec 10th Report to the Board of Supervisors from the Department of Health Services titled ” Measure O Update for Fiscal Year 2023-2024” which updates them on the progress of Measure O, our sales tax-funded Behavioral Health and Homeless Community Solutions Initiative.
Executive Summary: The Sonoma County Board of Supervisors requested an update on Measure O during the June 2024 Budget hearings. This update covers fiscal year 2023-2024 expenditures by category; estimated fund balance for fiscal year 2024-2025 and fiscal year 2025-2026; and provides a review of outcomes and numbers served from last fiscal year. Additionally, staff will highlight Measure O successes and discuss the approach for current and future Measure O funding.
Discussion: In November 2020 Sonoma County voters passed Measure O to provide essential funding for mental health and homeless services with 68.07% of the vote. Measure O, a one-quarter cent sales tax, was estimated to generate over $25 million each year for ten years to help protect essential mental health and homelessness services.
The Measure O Sales Tax Ordinance identified five categories of services to be funded with the revenue: 1) Behavioral Health Facilities, 2) Emergency Psychiatric and Crisis Services, 3) Mental Health and Substance Use Disorder Outpatient Services, 4) Homeless Behavioral Health and Care Coordination, and 5) Transitional and Permanent Supportive Housing. The Measure O Expenditure Plan designates a set percentage of funding for each category.
On December 7, 2021, the Board of Supervisors established a Citizen’s Oversight Committee to monitor the implementation of Measure O. The Citizen’s Oversight reviews expenditures for alignment with the intent of the Measure and does not make or recommend funding decisions.
On October 23, 2024, the committee voted to confirm that the Measure O expenditures for Fiscal Year 2023-2024 met the intent of the measure. This past fiscal year was the 3rd full year of Measure O funding. Tax revenues for the year again exceeded the initial projections made when voters considered Measure O. Tax receipts totaled $32 million as opposed to the initially projected $24 million (total revenues including interest and unrealized gains was $34.2 million) The surplus has provided capacity to pursue expanded opportunities within the established categories to support our community.
For Fiscal Year 2023-2024, below are the Measure O funds used/spent by category: · Behavioral Health Facilities: $7,055,539 · Emergency Psychiatric & Crisis Services: $12,425,458 · Mental Health & Substance Use Disorder Outpatient Services: $1,275,496 · Behavioral Health Homeless & Care Coordination: $7,842,652 · Transitional & Permanent Supportive Housing: $3,345,616 The total projected Measure O revenue for FY 2024-2025 is $32,865,501.
In FY 24/25 a total of $66.2M of Measure O resources are available for programming, financed with $33.3 in fund balance and $32.9M of total revenues. The approved FY24-25 budget includes $37.5 million in expenditures for Measure O. The Department will be seeking $10.2 in additional appropriation in FY 2024-2025 Q4. Given the total planned expenditures of $47,739,541 for FY 2024-25 budget, the ending fund balance in June is projected to be $18,478,541.
Details of the various expenses by categories with additional information can be found in Attachment A Presentation.
The Mobile Support Team and Crisis Assessment Prevention and Education described below highlight recent updates from the Measure O-funded Mobile Support Team (MST) and Crisis Assessment Prevention & Education (CAPE).
· In December 2022, California Department of Health Care Services (DHCS) established a new Medi-Cal benefit providing 24/7/365 community-based mobile crisis intervention services to those experiencing a behavioral health crisis. On April 16, 2024, county staff launched Sonoma County’s 24/7 call center and a revamped Mobile Support Team (MST) to meet this need. The MST is partnering with SAFE (which serves Petaluma, Rohnert Park, Cotati and Sonoma State University) and inRESPONSE (which serves Santa Rosa)) to provide countywide coverage. The Sonoma County 24/7 call center and revamped MST is available to all Sonoma County residents regardless of insurance status. An additional $5M in Measure O funds are being held for contingencies from potential MST expansion based on future county and Regional Model City needs. The actual draw on the fund balance will be recalculated based on Federal Financial Participation action receipts from the Medi-Cal program.
· Crisis Assessment Prevention & Education (CAPE). CAPE provides school-based behavioral health support and interventions to schools in Sonoma County. Four mental health teams are strategically located across the county. CAPE is reinstituting in-person response to students experiencing behavioral health crisis and linking students to substance use disorder treatment services for to youth and young adults.. The program is active and expanding, providing services such as: direct linkage to County Behavioral Health services and navigating other health insurance to connect to treatment; substance use and suicide prevention and early intervention – educational presentations and campaigns, linkage, and referral; and peer support and groups. In the 2024-2025 school year , CAPE will be partnering with these schools: Analy High School and Laguna High School in West County; and Sonoma Valley High School, Creekside High School, Adele Harrison Middle School, Alta Mira Middle School, and Hanna Boys Center in the Sonoma Valley.
Successful Outcomes from Measure O
The Psychiatric Health Facility (PHF) has continued to operate at its full capacity of 16 beds, serving over 150 individuals annually due to Measure O funding.
The Crisis Stabilization Unit (CSU) served nearly 1,000 individuals and was also able to continue operations at full capacity due to Measure O until the current temporary closure due to facility issues. The Mobile Support Team has expanded into a Regional Collaboration that utilizes exciting new approaches to crisis response.
Measure O has also laid the groundwork for new programs launching this year, including CAPE, additional support for the Valley of the Moon Short Term Residential Treatment facility, and the expansion of Medi-Cal drug service.
This year also saw the finalization of incorporating Homelessness Services into DHS with Measure O providing 100% of funding for the Homeless Encampment Assistance and Resource Team (HEART) and Solving Obstacles for Unsheltered Lives (SOUL) programs, and a significant amount of funding ($4.2M) for George’s Hideaway. The George’s Hideaway project is a Permanent Supportive Housing (PSH) Project Homekey site near Guerneville. Measure O funds were used to support site renovation (including planning, water/sewer, and demolition work) under oversight of the Community Development Commission (CDC). This site will provide supportive care including therapy, substance use disorder care, benefit navigation, job training and life skills.
Also, in September of this fiscal year, the funds allowed for the release of the Measure O: Behavioral Health & Homelessness Community Solutions Notice of Funding Availability (NOFA) in the amount of $5.6 million, including $4.2 of Measure O funding and $1.4 million in Homeless Housing, Assistance and Prevention (HHAP) funding. The NOFA is open to applications from interested parties, community partners and any other local government agencies. The NOFA covers multiple program areas within each Measure O category with a specific focus on areas of identified need including on service navigation, staffing shortages, education/training and upstream approaches, peer support, individual and family counseling, and cultural competence. Additionally, the HHAP portion of the NOFA prioritizes permanent supportive housing, rapid rehousing, emergency shelter (congregate and non-congregate), street outreach, capital expenses for permanent supportive housing or enhancing existing emergency shelter projects for privacy, and lastly, operating subsidies for permanent supportive housing and rapid rehousing.
To determine priorities and opportunities for strategic application of Measure O funding in the future, department leadership plans to conduct a detailed budget and program analysis and identify areas where Measure O funding could be used and where other funding sources could be leveraged. The goal is to separate annual, recurring commitments from the projects where funding could be shifted as they mature and/or become self-sustaining.
The remaining Measure O funding would be a mix of unallocated fund balance and expected revenues. Staff plans to release a recurring Notice of Funding Availability (NOFA) for which Community Based Organizations and local government partners could apply. Through an open application process, a Community Advisory Panel will be selected to help review NOFA proposals and make recommendations to the Board for final approval. Staff will present the outlines of this proposal to the Board for further guidance and direction at the Board meeting.
Homeless Emergency Assistance Program Association 