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.

Forging the Future

Forging the Future Flyer Download

If you have an interest in attending this meeting in Sacramento, contact me at 707 230-1198 or gfearon@gmail.com.

FY 23-24 Measure O Report & Latest NOFA Awards

Coming up soon at the Sonoma County Board of Supervisors will be the adoption of the FY 23-24 Measure O Annual Report, and $4 million more Measure O NOFA Awards for FY 25-26. Two more NOFAs will be announced by the Department of Health Services in the next four months from Measure O and from Opioid Settlement funds. Both total almost $25 million.

MeasureO_AR2024_FINAL_ADA-3 Download

Upcoming Public Actions

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 18^th.
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 28^th, 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.

Sonoma County Measure O Meeting Fund Balance Report

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?

Behavioral Health Transformation Beginning

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.

Homeless Emergency Assistance Program Association

Behavioral Health Board Training Materials for Prop One Implementation

Proposition One Update Presentations

Commission on Behavioral Health Mtg

Government Transformation