Category: Uncategorized

Two HEAPA Grants

On December 21st, the HEAPA Board of Directors approved two small grants to community agencies serving our unhoused community. The first was a general operating grant to Sonoma County Acts of Kindness for $1,000 in support of their efforts to provide personal clothing, sleeping gear, and other vital resources for those they serve on the streets. The group has always been of service at encampments, in locations where the unhoused congregate, and has operated almost entirely by volunteers and community giving.

The second grant for $1,580 was given to Sonoma Applied Villages Services (SAVS) for supplies and forty hours of community organizing support for their effort to establish a sanctioned camp on public land. Convinced that recent federal actions to change the rules concerning funding of homeless programs will result in fewer successful housing placements, SAVS is renewing their decade-old insistence for a central, sanctioned housing location.

HEAPA is a nonprofit charity, organized under federal regulations, and donations to it are permitted deductions under the federal IRS rules (84-2299731). The mailing address is 2040 Elizabeth Way, Santa Rosa, CA. 95404.

Sonoma County’s HealthCare Crossroads

Short Summary

A forum on the major threats facing healthcare access for the Latino community in Sonoma County was held on November 14th.

Long Summary

At the Los Cien Health Care Forum, where leaders discussed dire threats to community healthcare. Keynote speaker Francisco J. Silva detailed how federal policies like HR 1 and a state ballot initiative could devastate Medi-Cal and community clinics, disproportionately impacting Latino families. A panel of local health leaders reinforced the urgency, discussing the local impact of these cuts, the rise in uninsured patients, and the strain on services. The core message was a call for unified community action to protect the healthcare safety net.

Membership and Business Support

A membership program has been relaunched after being closed for reimagining. A dedicated email about membership will be sent, including a link to join online. A new non-profit and business directory is being developed to provide a trusted list of services. There is a focus on creating programs to support business owners and professionals inclusively, rather than forming a formal business chamber.

Los Cien Health Care Forum

The event began with a welcome by Herman G. Hernandez, Executive Director of Los Cien. Acknowledgments were given to partners, including the Luther Burbank Center, and the design team volunteers. The BRIDGE alumni program (Building Representation, Inclusion, Diversity, and Governance Excellence) was recognized. A tribute was paid to Rick Nolan, the retired CEO of the Luther Burbank Center, for his decade-long partnership and support of the Latinx community.

Keynote on Threats to California Healthcare

Keynote speaker Francisco J. Silva, CEO of the California Primary Care Association, discussed major challenges facing healthcare.

Impact on Latino Communities:

Cuts to Medi-Cal and community health centers are direct cuts to the Latino community, as they form the largest group of enrollees and patients.

Federal HR 1 Impacts:

This federal law represents a significant rollback of Medicaid access. It imposes work requirements and frequent eligibility hurdles. Nationally, it could cut $1 trillion from Medicaid and strip $32 billion from community health centers. In California, it is estimated that 1-3 million people could lose Medi-Cal coverage.

State-Level Cuts:

State proposals aim to limit Medi-Cal for undocumented immigrants by freezing enrollment and introducing a $30 monthly premium. These changes threaten the “Health Care for All” progress made in the state.SEIU UHHW Ballot Initiative. A statewide ballot initiative filed by SEIU UHHW is described as the “most dangerous attack on community health centers in California history.” An independent analysis projects the initiative would: Divert $1.7 billion from patient care into penalties; Push a majority of clinics into financial deficit, with 47% at risk of closure; Force cuts to enabling services like translation, transportation, and community health worker programs. The public is urged to read petitions carefully and understand that this measure could cripple the healthcare safety net.

Local Impact in Sonoma County

One in three residents of Sonoma County (approximately 140,000 people) is on Medi-Cal. Proposed policy changes will double the county’s administrative workload for recertifications while simultaneously cutting its caseload-based funding. The cost of uncompensated care will financially impact everyone, from private employers to public services. Safety-net providers are already seeing an increase in patients, with the Jewish Community Free Clinic reporting a 25% rise in the last 60 days. There is a growing level of fear among patients, with some rationing visits or hesitating to seek care due to immigration concerns.

Community Collaboration and Response

Sonoma County’s healthcare leaders are working together to create solutions for the impending crisis. The community is advised to seek information from trusted sources like 211, OpenDoorsSC.com, and local health organizations to combat misinformation. Health centers affirmed that they do not ask for or share patient immigration status with government agencies. Partnerships are key, with organizations like Kaiser Permanente investing in community health grants and housing projects based on shared needs assessments.

Behavioral Health Crisis

The panel highlighted a severe and worsening crisis in behavioral and mental health. There is a critical shortage of services, clinicians, beds, and facilities for all populations, not just those on Medi-Cal. The county’s behavioral health system currently has a waitlist of over 500 people for its high-need services. This crisis existed before the current policy threats and is expected to be exacerbated by them.

Call to Action

Leaders emphasized that local action is critical, as federal and state support is no longer reliable. The community is called to get involved, advocate, and hold legislators accountable. Local control over funding through measures like Measure O is crucial for sustaining services. Training future healthcare professionals within the community is a key strategy, as many tend to stay and practice where they train.

Gen H Sonoma County State of Housing Presentation at Redwood Credit

Short Summary

A deep dive into Sonoma County’s housing crisis and the community-led policy solutions being proposed to address it.

Long Summary

You listened to a presentation by Generation Housing on the state of the housing crisis in Sonoma County. The discussion highlighted a shortage of over 50,000 homes, which impacts everyone from young families to seniors, leading to school closures and workforce challenges. The event launched the ‘Housing for Healthy Communities’ initiative, focusing on state laws to encourage building more ‘missing middle’ housing and creating starter homes. The central theme was that a broad, community-wide advocacy effort is essential for creating meaningful change.

2025 State of Housing Report

The report focuses on telling a housing story using data to address successes, myths, and the intersectional nature of housing. There is a significant housing shortage at all income levels, particularly for affordable housing. The crisis is defined by the impact of this shortage on education, health, the economy, and the climate. The housing shortage is the result of 75 years of policy, requiring a multi-faceted approach (“silver buckshot”) rather than a single solution.

Housing & Community Impact

A panel of experts shared how the housing crisis affects various sectors of the community. Youth & Families: Sonoma County is losing homegrown talent as young people, including recent graduates and community leaders, are forced to leave due to high living costs. Education System: Teachers and school staff cannot afford to live in the community, leading to high turnover and negatively impacting student success. This has contributed to declining enrollment and school closures.

Workforce & Young Adults: The lack of affordable rental options is a “missing rung on the ladder” to homeownership, causing young adults to delay forming independent households or leave the area.

Seniors & Caregivers: Seniors on fixed incomes, even homeowners, face extreme cost burdens from rising insurance and utility costs. The caregivers they depend on are also priced out of the region, threatening seniors’ ability to age in place with dignity. Immigrant Community: Immigrants and foreign-born residents face immense barriers to housing stability, with homeownership often taking over 25 years to achieve. Housing policy needs to center the humanity of these community members.

Permanent Supportive Housing: This model is the most effective way to end homelessness but is very expensive to operate. Housing Choice Vouchers, which cap a resident’s rent at 30% of their income, are essential for the financial viability of these projects.

Benefits of Affordable Housing: A Napa County study revealed that the greatest benefits of affordable housing were social and economic stability, stress reduction, and the ability for residents to engage in long-term financial planning, such as saving for a home down payment.

Calculating Sonoma County’s Housing Need

The established goal is to build approximately 58,000 new homes by 2030. This number was validated through three independent methods that all produced similar results: Household Formation Deficit: A historical deficit of 38,000 households that should have formed, plus a

future need for 20,000 more. Property Value Method: The number of homes needed to bring the disproportionately high cost of land back to a normal market rate. Vacancy Rate Method: The number of homes needed to achieve a healthy 5% vacancy rate, as Sonoma County currently has one of the lowest per-capita availability rates in the state.

Independent analysis confirms the region has the capacity to build roughly 52,000 new homes within existing urban growth boundaries.

“Housing for Healthy Communities” Initiative

This is a new policy initiative focused on creating “missing middle” housing by encouraging jurisdictions to opt into two state laws.

SB-10: Allows for the creation of up to 10 housing units on a single parcel in transit-oriented or infill areas.

AB-1033: Allows Accessory Dwelling Units (ADUs) to be sold separately as condominiums, creating new starter-home opportunities without new construction. The goal is to build gentle density and create more diverse housing options, similar to older, walkable neighborhoods, by reversing decades of exclusionary zoning.

Fiscal Benefits of Infill Housing

Denser, infill housing provides a significant financial benefit to cities facing budget deficits. It maximizes property tax revenue per acre. An apartment building can generate $17M-$35M in taxable value per acre, compared to $9M-$11M for single-family homes. It minimizes long-term liabilities for cities. Delivering and maintaining infrastructure like roads, water, and sewer is significantly cheaper on a per household basis in denser areas.

Behavioral Health Board Annual Report/Integrated Plan Committee Proposed

The Sonoma County Behavioral Health Board Executive Committee accepted a recommendation that it place the establishment of an Annual Report/Integrated Plan Subcommittee on the agenda for its November 18th monthly meeting. The Board’s bylaws require it deliver an annual report on programs in the Department of Health Services, and the passage of Proposition One defines its role in advising the Department and the Board of Supervisors on the FY26-29 Integrated Plan.

More on the Few

This morning, at the meeting of the Sonoma County Board of Supervisors, a discussion was held which illuminated the near future of communication between state and local government. After years of managed anguish over the growing impact of unfunded mandates required of local government by the State Legislature, our Board seems to have reached a boiling point. In particular, the expansion of authority given local government concerning who can be deemed “gravely disabled”. Gravely disabled now means a condition in which a person, as a result of a mental health disorder, severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.

The bill expands the definition of “basic needs” to include not just food, shelter, and clothing, but also access to necessary medical care and personal safety. 

Counties have until January 1, 2026, to implement Senate Bill 43 (SB 43). Six counties are currently implementing SB 43; however, limited data is publicly available. Preliminary data from a similar size county reflects a 25% increase in conservatorships from January 2024 – August 2025. Sonoma County has 200 people on conservatorship; a 25% increase would see the conservatee population grow to 250.

Over the last five years, the county’s Lanterman-Petris-Short conservatee caseload has ranged from 186-207 clients. To address the existing deficits and anticipated increases, the Human Services Department will require two Full Time Equivalent allocations. Similarly, the Department of Health Services will require two Full Time Equivalent allocations.

To prepare for SB 43, the county has taken several actions. A series of informational meetings are planned through 2025 with community, public, and private stakeholders, an SB 43 training will be held in November 2025, and a limited number of substance use disorder beds have been identified for conservatees meeting certain withdrawal management criteria. In Spring 2025, the county secured a $67.8 million Bond Behavioral Health Continuum Infrastructure Program award from the California Department of Health Care Services. Long-term, this will allow the county to add more treatment beds for substance use disorder and conservatee clients. No additional funding has been provided to counties to implement SB 43.

Data

As of September 2025, Sacramento, San Bernardino, San Diego, San Francisco, San Luis Obispo, and Stanislaus County are implementing SB 43. Approximately 52 counties opted to begin implementation on January 1, 2026. Data on the impact of SB 43 will be available in 2026 as counties comply with data reporting requirements. In the interim, limited data is publicly available. Initial estimates indicate the number of conservatees in San Luis Obispo County increased 25% and 29% in San Francisco County. Similar increases in Sonoma County would see the number of conservatees increase from 200 to 250 – 258. Over the last five years, the county’s LPS conservatees caseload has ranged from 186-207 clients as illustrated on page 10 of Attachment 3 – Presentation.

Placement and Treatment Considerations

In FY 2024/2025, the Department of Health Services (DHS) spent approximately $11.7 million placing 197 conserved individuals. Placement is determined by the individual’s least restrictive placement order and includes locked settings such as Institutions for Mental Disease, skilled nursing facilities, and mental health rehabilitation centers.  It also includes unlocked settings like residential care facilities or other transitional or supportive housing settings.  DHS contracts with a number of providers both locally and regionally in an effort to ensure individuals are not being held unnecessarily in locked settings such as psychiatric hospitals, emergency departments, or Sonoma County Jail. 

DHS places strong emphasis on utilizing local placements so individuals have the ability to be near their primary support networks. Costs for each facility varies by its type and level of care needs the individual presents with upon admission. The average cost for placing an LPS conservatee is $60K annually. Alternatively, the annual cost to place a murphy conservatee is approximately $150K to $300K depending on type of placement and acuity level of the individual being placed.

Sonoma County currently has 65% of clients placed out of county to receive mental health treatment. Many facilities are over 100 miles away from Sonoma County. This can create obstacles with arranging for in-person court appearances, for county staff to complete periodic visits, and for families to see their loved ones. Being placed out of county can also create challenges when the client no longer meets criteria for LPS conservatorship and needs to be reintegrated back into the Sonoma County Mental Health services system. In the short term, the county has identified up to ten (10) SUD withdrawal management beds that are available for conservatees meeting certain criteria. This temporary option is intended to provide some relief while longer-term measures are being developed (e.g. Bond Behavioral Health Continuum Infrastructure Program construction).

In anticipation of future placement needs for individuals conserved under the enhanced grave disability SB 43 criteria, it is estimated that DHS will need an additional $1.4 – $2.9 million in new placement costs.  Costs are subject to type of facility, length of stay, and treatment needs of the conserved individual.

Staffing

The LPS conservatee population has grown by 7% over the last five (5) years without a corresponding staffing increase. To address the existing 2025 deficits, the Human Services Department (HSD) will require two Full Time Equivalent allocations (FTE) and DHS will require two FTEs. To address the 2026 deficits as a result of SB 43 implementation, DHS will require two FTEs. A total of six FTEs (2025 needs and 2026 SB 43 implementation needs) are needed to provide services to conservatees for both HSD and DHS.

“Funding expected to be utilized will come from Measure O, and a scattering of other DHS program cuts.” explained Nolan Sullivan, DHS Director, in response to Board questioning.

The Board of Supervisors responded by asking its staff to explore legal and advocacy initiatives with all state counties to increase state compensation for the impacts of SB43.