Presentations Are Not Stakeholder Engagement

I attended the majority of the public stakeholder meetings identified in the Department’s Community Planning Process (CPP) in the Draft Integrated Plan, including the BHSA Steering Committee, the Community Planning Program Workgroup, the Behavioral Health Board, Countywide Town Halls, and the dedicated Housing Workgroup. What I witnessed was a repetitive series of presentations from Department staff and consultants focusing on the the transition of MHSA funding requirements to those contained in the BHSA Behavioral Health Transformation. Questions from participants concentrated on how current programs initiated under the last three-year MHSA Integrated Plan could be continued despite a shift of 30% of the funding to “Housing”, and the transfer of popular innovation grant authority to the State.

Rarely in the process did staff address what they alluded to as the “other 90%” of the Plan program funding, now for the first time mandated to be included. When they did, it was to complain about the fact that the Department’ Fiscal Team had not provided them with any guidance on the Departmental finances required to be within the Plan. After the first four presentations of the same PowerPoint, I perceived that most committee members stopped asking questions, and some community members stopped attending. As the only member from the Behavioral Health Board at these meetings, I began to detect that an enormous information and participation gap growing between the BOS-Appointed Behavioral Health Board and the Department-selected Behavioral Health Steering Committee. The latter consisted on Department staff, consultants, and contractors. Almost all seemed to be vulnerable to charges of conflict of interest, and seldom asked any but superficial questions.

When I attempted to record the meetings using an advanced digital personal assistant device (Fieldy) to document the stakeholder input, staff objected, and forced me to stop. I do not believe that staff finds value in allowing transparency in their work. The lack of timely minutes, advance meeting presentation materials, and the reluctance by staff to utilize online Plan Comment tools, has severely restricted public engagement and review.

The questions I asked were almost entirely ignored, and usually viewed as hostile, especially when I inquired when reports from the BH Steering Committee would be shared with the Behavioral Health Board. Were I to have been allowed to continue on the Board, I would have requested that full reports and recommendations from these meetings be forwarded to the Behavioral Health Board’s Integrated Plan Subcommittee for their report to the full Behavioral Health Board by the beginning of the formal public Open Comment hearing at their May meeting.

The Department’s Plan submission details the many meetings it hosted in compliance with the State’s stakeholder involvement requirements. But effective Plan development and engagement is not conducting meetings of your own staff, contractors, and consultants to review your latest interpretation of evolving State requirements. I saw almost no changes to the presentations, to the proposed Plan design, and finally to the Draft Plan, in the six months from September of 2025 to February of 2026. My attempts at providing insight on Integrated Plan processes being discussed at other neighboring county Behavioral Health Board meetings, California Association of Local Behavioral Health Boards and Commission board meetings, and State Behavioral Health Commission meetings I was attending were dismissed. It was no surprise to me when Departmental staff asked me not to continue my attendance on the Behavioral Health Steering Committee because “We believe your intentions are not consistent with ours”.

Within the Draft Integrated Plan is a paragraph which illustrates the failure of open engagement. It indicates that the planning process gathered important insights into the operation of homeless facilities and services in the county.

“At the recommendation of the Steering Committee, SCBH conducted Housing
Focus Groups in August and September 2025 with individuals who had lived
experience of homelessness and behavioral health challenges. Participants
identified safety concerns, lack of privacy in shelters, inconsistent rule
enforcement, barriers to consistent case management, and insufficient supports
for individuals with serious mental illness. They recommended trauma-informed
housing environments, enhanced onsite clinical and peer services, expanded
outreach teams, and practical supports such as dog kennels to support
employment access. Participants also identified transportation, digital access,
and documentation barriers, recommending monthly bus passes, free internet
access at service sites, and assistance obtaining identification, Medi-Cal, and
mobile phones. These insights directly shaped priorities for integrated housing
and behavioral health service models, expanded case management, strengthened
peer workforce roles, and improved transportation and digital access supports.”

None of this information was shared with the Sonoma County Homeless Coalition, the County’s Continuum of Care Governing body, nor was there any attempt to validate or utilize the feedback to engage the largest single set of targeted stakeholders/consumers.

Nevertheless, the Department’s stakeholder process did confirm the Department’s belief that previous investments using innovation projects have found deep support within the community. Almost all of the priorities identified in the concluding paragraphs of the Plan’s Community Planning Process Stakeholder Engagement originated in early memberships and comments a year ago. It’s too bad no real work was done in the interim to actually engage participants in turning those ideas into collaborative projects.

“Across all engagement activities, stakeholders consistently emphasized the value
of culturally grounded and lived-experience perspectives. Community members
called for strengthening the SCBH Latinx Clinic, expanding culturally rooted early
intervention programs, investing in peer-led wellness centers, and hiring staff
with lived experience. Stakeholders highlighted the importance of traumainformed, disability-sensitive approaches and the need to evaluate both evidence-based and community-created practices. There was strong support for improving data systems, integrating quantitative and qualitative measures, and ensuring outcomes reflect community-defined success.”

“Through this extensive and collaborative planning process, the FY 2026–2029
BHSA Integrated Plan reflects the priorities identified by Sonoma County’s
diverse communities. These include expanding housing-linked behavioral health
supports; strengthening crisis response and early intervention services;
investing in culturally grounded and peer-led models; improving real-time data
and response systems; and enhancing transparency and communication. Input
gathered through meetings, focus groups, surveys, and listening sessions
directly informed the Plan’s strategies, and SCBH remains committed to
continued stakeholder engagement throughout implementation.”

Homeless Action! Feedback

Behavioral Health Services Act (BHSA) 

3-Year Integrated Plan (draft)

Over the past 2-3 weeks members of an informal Homeless Action! Committee worked to understand and analyze this 192-page document.   Our memo below captures the major problems we found.

SUMMARY of the Plan

  • Spends approximately $611.0 million over 3 years.
  • Funding from Federal Financial Participation (FFP): $187.4 million, (BHSA Behavioral Health Services Act): $153.3 million; Other state funding: $99.5 million; 2011 Realignment: $71.6 million; 1991 Realignment: $69.6 million; Opioid Settlement Funds: $13.7 million; Substance Use Block Grant: $8.1 million; State General Fund: $4.8 million; County General Fund: $1.6 million; Mental Health Block Grant: $1.2 million.
  • Confirms Sonoma County’s Homeless Division as part of the Behavioral Health Division of the Department of Health
  • Who Will Be Served (Annual Estimates)

Rental Subsidies: ~70 individuals
Operating Subsidies: ~200 individuals
Landlord Mitigation Supports: ~100 individuals
Participant Assistance Funds: ~300 individuals
Housing Navigation & Tenancy Services: ~130 individuals

  • This plan limits help to those with acute mental illnesses and substance abuse disorders who are eligible for MediCal.
  • One part of the plan is suicide prevention – particularly for middle age and senior men.

APPRECIATION

We greatly empathize with the thinkers and writers of this 200-page document required by government funders.  It’s not simple or easy to produce such a detailed plan that satisfies the State’s requirements.   The plan combined multiple funds and a reorganized county staff with the intention of making the most positive change for the people of Sonoma County as possible.   

It calls out the higher rates of homelessness for American Indian/Alaska Native and Black residents, as well as high suicide rates for middle age and older men.   It attempts to integrate three county-owned facilities into a unified purpose and structure.   It provides money for homeless prevention, funds mobile outreach, and a program which provides health care, mental health and social services to individuals.  

PROBLEMS

There is a critical need for honest feedback because 1) the public money spent in this plan ($611 million dollars) is enormous, and 2) those who are left behind as this plan is implemented will suffer greatly.  The key issues below are some of the crucial problems and deep systemic weaknesses in the county plan.

  1. Lack of Consultation with Community.     The plan was released with less than a month for public comment.  It was released without a summary in clear, straight-forward language.  Many stakeholders, including homeless people and people living with behavioral health problems and substance abuse disorders, were not included.  The Homeless Coalition and Catholic Charities are the most obvious omission, but SHARE Sonoma County, Homeless Action!, the LEAP board, Acts of Kindness, Unsheltered Friends Outreach, and other groups with lived experience are among those missing.
  2. Limitation of Service.  The entire $611 million is earmarked forpeople with acute behavioral (mental) health problems and those with substance abuse disorders.  Housing and other support is entirely missing for the approximately 1,000 homeless people who do not fall into these categories as well as housed individuals living with less-than-acute mental illness. 
  3. Strategic Silos   The county and several cities have strategic plans, often produced at significant cost by consultants.  These were, apparently, not considered in the making of this plan.  The most obvious example of this is the March “Department of Health Services (DHS) Organizational Assessment Homeless Services Division & Sonoma County’s Role as Lead Agency for the Continuum of Care, March 19, 2026”.  This report recommended that the Homeless Division be integrated into the Behavioral Health Division, but many other aspects of this report are ignored in the 3-year plan.  If homeless services are fragmented due to this, homeless people are at risk of becoming a secondary issue. 
  1. Data Problems   The Behavioral Health Department uses SmartCare.  County homeless data is collected through HMIS.  The two data systems are not integrated.   Without a difficult and fast-paced integration, data to assess this plan will be useless, and many individuals will fall through the statistic crack.  The plan cites that of 520 eligible individuals experiencing unsheltered homelessness, zero (0) were recorded as moving into permanent housing.  We hope this is a data problem and not reality.    The Coordinated Entry System which has been carefully built over several years, and proven to be effective, does not seem to have a role in this plan.  It’s important to ensure that the County will be able to track homeless outcomes as well as clinical visits.  There is no accountability or metrics for this.
  2. Medical vs Social Model.    The plan excludes those who are not eligible for Medi-Cal and cannot be diagnosed with a medical disease.  Services are tied to eligibility and diagnosis IF you can get a Behavioral Health referral through ACCESS.  This will exclude many undocumented people.  That is a huge red flag.  The medical-clinical model has been rejected by the disability movement for over 50 years.  With this plan, we risk categorizing our poorest and most vulnerable friends and neighbors as patients who must accept what they are told for their own good.  This is a set up for disempowerment at the time when people most need to have control of their lives.
  3. The CalAIM problem.  The 3-year plan relies heavily on the CalAIM program of Medi-Cal.  The bureaucratic load of Cal AIM will “price out” smaller, more grassroots agencies.   Cal AIM is a force that will put people into a clinical system which will limit support their overall ability to stay housed.
  4. Lived Experience.   The plan speaks of people with Lived Experience and peer support but there is no formal method of integrating feedback or any decision-making power to those with the lived expertise of mental health problems and/or homelessness.
  5. People of Color (BIPOC).   The plan acknowledges crucial disparities among American Indian/Alaska Native, Latino and Black residents in homelessness, arrests and unmet needs but only 3 groups have been selected to respond to a Request for Proposals in this area.  Only 126 individuals in this catagory are expected to be served annually.

SOLUTIONS

  1. Fill 100% of rooms for homeless people in County-owned facilities through the Coordinated Entry System.
  2. Begin a formal SmartCare-to-HMIS Coordination immediately with a 3-month timeline for completion.
  3. Set up a Hub-and-Spoke administrative system whereby larger agencies administer CalAIM for smaller agencies, allowing the grassroots agencies to focus on direct client care.
  4. Expand scope of the plan to include undocumented individuals who do not qualify for Medi-Cal and homeless individuals who do not qualify as acutely mentally ill or living with substance abuse disorders.
  5. Insist upon a robust and meaningful community discussion before further implementation. 

My view of Sonoma County’s Proposed Proposition One FY 26-29 Behavioral Health Three-Year Integrated Plan

Greetings!

I’ve been asked by many to provide my perspective on the County’s development of the Proposition One’s required Sonoma County Three-year Integrated Plan for Behavioral Health and Substance use Disorder Services beginning July 1, 2026.  Having served on the County’s Behavioral Health Board for the last two years, and as Chair of the Board’s Subcommittee charged with its review and report until early April, I was in a unique position to monitor the County’s performance.

The instructions from the California Department of Health Care Services to counties, concerning the process of developing the Integrated Plan, represented a significant expansion of the programs and funding sources involved, as well as the variety of additional stakeholders required to be included in the planning.  County staff, complaining of delayed state direction, consumed nine of the twelve months of planning providing stakeholders with information from the initiative that impacted the previously reported MHSA funding (Prop 63).   How was Sonoma County was going to add substance abuse services, spend thirty percent of the funds on housing for clients, and half of the Full support Partnerships on those under 25 years of age without any additional funding?  When combined with the failure of the Health Department’s Fiscal Division to deliver to the Department any useful information concerning the remaining 90% of the Plan’s responsibility, the proposed stakeholder engagement and Board review of the proposed Plan quickly became an exercise in unproductive meetings with repetitious powerpoint presentations.

The Subcommittee I chaired soon found themselves useless in their attempt to build an understanding of the work of Plan development, and as a result could not adequately assist in informing required stakeholders.  Adding to the barriers to engagement, one of the largest stakeholder oversight entity (Sonoma County Homeless Coalition) was never approached by the Department, or given a chance to participate.  

The result is a year of missed opportunities to inform and consider the views of an expanded stakeholder community concerning the expenditure of over a billion dollars of government funding for those with behavioral health and substance use disorder needs. 

Gregory Fearon

Questions: BH Board’s Annual Report/Integrated Plan Committee Meeting, March 3rd, 2026.

Post was the generated by submitting a summary of the meeting developed by Fieldy to Adobe Acrobat’s AI Assistant, and choosing to ask it to pursue its questions and suggested research.

Summary

Navigating Sonoma County’s Behavioral Health Crossroads

Sonoma County’s behavioral health and homelessness services are facing a pivotal moment due to severe funding cuts and shifting priorities.1

  • Critical Funding Threats: Federal Medicaid reductions and dwindling local funds jeopardize essential services, with Measure O playing a vital role in current support.2
  • Strategic Shifts: The county is reorganizing teams, seeking new partnerships, and focusing on residents with higher behavioral health needs to adapt to the changing landscape.3
  • Community Engagement: Transparent processes and proactive outreach to local leaders are prioritized to maintain support and awareness.4
  • Achievements Amidst Uncertainty: Despite challenges, key programs like the Crisis Stabilization Unit and Crestwood Healing Center are making significant impacts.5

Understanding these dynamics is crucial for stakeholders aiming to support, advocate for, or adapt to the evolving behavioral health environment.Ask a question

Funding Challenges and Strategic Responses

Challenge/AdjustmentDetails
Federal Medicaid CutsAnticipated reductions threaten core behavioral health and homelessness services1
Measure O RelianceFunds 58.33 staff; projected ending balance of $7.1M is a major concern2
Realignment Fund DepletionLocal funds are dwindling, increasing fiscal pressure3
NOFA ($10M)New funding opportunity to support at-risk programs; deadline: Sept 174
Strategic ReorganizationHomelessness team moving under behavioral health to leverage Medi-Cal billing5
Allocation AdjustmentsPossible reallocation of NOFA funds to support struggling providers6

Key Program Achievements and Impact

  • The Crisis Stabilization Unit is now almost fully staffed and operational, addressing previous shortages.1
  • QPR suicide prevention training at Analy High School has boosted counselor confidence in crisis response.2
  • Crestwood Healing Center, a 16-bed psychiatric facility, is reducing reliance on private hospitals.3
  • Measure O supports over 58 essential mental health and crisis service staff across the county.4

Upcoming Actions and Accountability

  • Develop a data-driven proposal for a second psychiatric health facility to cut private hospital costs.1
  • Continue monthly leadership meetings with the new ad hoc committee to align on Measure O priorities.2
  • Launch community outreach to inform local groups and officials about funding impacts and Measure O’s role.3
  • Search for interim and permanent leaders for the reorganized homeless services team is underway.4

Evaluate potential impacts of Medicaid cuts on local health programs

The document highlights several potential impacts of Medicaid cuts on local health programs, particularly in Sonoma County. Below is an evaluation based on the information provided:

1. Financial Strain on Behavioral Health and Homelessness Services

  • Impact: Federal Medicaid cuts are described as a “seismic shift” in healthcare funding, creating significant financial uncertainty for Sonoma County’s behavioral health and homelessness services. This could lead to reduced funding for critical programs that rely heavily on Medicaid/Medi-Cal reimbursements.
  • Example: The county’s Realignment fund balance is already dwindling, and the projected Measure O ending balance of $7.1 million is causing concern among leadership. This indicates that the county may struggle to sustain current service levels without additional funding sources.

2. Risk to Existing Programs

  • Impact: Many homeless and housing providers are in urgent need of financial support to sustain their operations. Medicaid cuts could exacerbate this issue, potentially leading to program closures or reduced services.
  • Example: The document mentions the release of a $10 million Notice of Funding Availability (NOFA) to support programs facing funding loss. This suggests that the county is already taking steps to mitigate the impact of funding reductions, but the long-term sustainability of these programs remains uncertain.

3. Increased Pressure on Local Funding Sources

  • Impact: With federal Medicaid cuts, local funding sources like Measure O will face increased pressure to fill the gap. However, Measure O’s projected ending balance of $7.1 million may not be sufficient to address the growing needs.
  • Example: Measure O currently funds 58.33 employees who provide essential mental health and crisis services. Any reduction in funding could jeopardize these positions and the services they provide.

4. Challenges in Expanding Services

  • Impact: Medicaid cuts could hinder the county’s ability to expand services to meet growing needs. For example, the planned mental health unit at the county jail is already stalled due to insufficient funding, and further cuts could delay or cancel similar projects.
  • Example: The allocated $39 million for the mental health unit is insufficient for current construction costs, and the state has not allowed for plan alterations. This highlights the difficulty of expanding services in the face of financial constraints.

5. Increased Reliance on Strategic Partnerships

  • Impact: The county may need to rely more heavily on strategic partnerships and community advocacy to maintain vital services. This could lead to increased collaboration but also require significant effort to align priorities and secure additional resources.
  • Example: A new ad hoc committee has been established to oversee Measure O funding and enhance collaboration with partners. This indicates a proactive approach to addressing funding challenges, but the effectiveness of these partnerships will depend on the availability of resources.

6. Potential Service Integration

  • Impact: The reorganization of the homelessness team into the behavioral health department is aimed at leveraging Medi-Cal billing and improving service integration. However, Medicaid cuts could undermine these efforts by reducing the available funding for Medi-Cal services.
  • Example: The strategic pivot for homeless services to focus on residents with higher behavioral health needs may be compromised if funding is insufficient to support these specialized services.

Conclusion

Medicaid cuts could have far-reaching impacts on local health programs in Sonoma County, including financial strain, risk to existing programs, challenges in expanding services, and increased reliance on local funding and partnerships. While the county is taking proactive steps to address these challenges, such as releasing the $10 million NOFA and reorganizing services, the long-term sustainability of these efforts remains uncertain without additional funding sources or policy changes.

What can I help with next?
Brainstorm alternative funding sources for homeless services
Summarize key challenges faced by Sonoma County health programs

Summarize key challenges faced by Sonoma County health programs

The document outlines several key challenges faced by Sonoma County health programs, particularly in the areas of behavioral health and homelessness services. Below is a summary of these challenges:

1. Financial Uncertainty

  • Federal Medicaid Cuts: Anticipated reductions in Medicaid/Medi-Cal funding are described as a “seismic shift” in healthcare funding, creating significant financial uncertainty for the county’s health programs.
  • Dwindling Local Funds: The county’s Realignment fund balance is decreasing, and the projected Measure O ending balance of $7.1 million is causing concern among leadership about the sustainability of current services.

2. Project and Funding Gaps

  • Mental Health Unit at County Jail: The planned mental health unit is stalled due to insufficient funding. The allocated $39 million is not enough to cover current construction costs, and the state has not approved plan alterations.
  • Support for Homeless and Housing Providers: Many providers are in urgent need of financial assistance to sustain their operations, and the county is struggling to meet these needs.

3. Strategic Adjustments

  • Reorganization of Services: The homelessness team is being moved into the behavioral health department to leverage Medi-Cal billing and improve service integration. However, this transition may face challenges due to funding constraints.
  • Focus on Behavioral Health Needs: The county is pivoting its homeless services to prioritize residents with higher behavioral health needs, which may require additional resources and specialized services.

4. Leadership and Operational Challenges

  • Leadership Transition: The county’s homeless services unit is undergoing a leadership transition, and there is an active search for interim and permanent leaders to guide the team.
  • Staffing and Operational Issues: While the Crisis Stabilization Unit (CSU) has addressed staffing shortages and is now operational, other programs may face similar challenges if funding is reduced.

5. Community Engagement and Advocacy

  • Need for Transparency: The county is working to ensure transparent processes for the $10 million Notice of Funding Availability (NOFA) to support struggling programs.
  • Community Outreach: Plans are being developed to inform community groups, mayors, and councils about Measure O’s impact and the financial challenges ahead.

Conclusion

Sonoma County health programs are facing significant challenges due to financial uncertainty, project funding gaps, and operational hurdles. While the county is taking steps to address these issues through strategic adjustments, community engagement, and funding initiatives like the $10 million NOFA, the long-term sustainability of these efforts remains uncertain without additional resources or policy changes.

What can I help with next?
Brainstorm advocacy strategies for sustaining Medicaid funding
Analyze potential impacts of funding gaps on mental health services

Brainstorm advocacy strategies for sustaining Medicaid funding

Based on the document, here are potential advocacy strategies for sustaining Medicaid funding in Sonoma County:

1. Community Engagement and Awareness Campaigns

  • Strategy: Launch a public awareness campaign to educate residents, community groups, and local leaders about the importance of Medicaid funding for behavioral health and homelessness services.
  • Implementation:
    • Organize town hall meetings and workshops to discuss the impact of Medicaid cuts.
    • Use social media platforms and local media outlets to share stories of individuals and families who benefit from Medicaid-funded programs.
    • Develop informational materials that outline the consequences of funding cuts and distribute them to community stakeholders.

2. Collaboration with Local Government and Stakeholders

  • Strategy: Strengthen partnerships with local government officials, nonprofit organizations, and healthcare providers to present a unified front in advocating for Medicaid funding.
  • Implementation:
    • Work closely with the newly established ad hoc committee to align advocacy efforts and ensure transparency in funding processes.
    • Engage mayors, city councils, and other local leaders to support resolutions or statements opposing Medicaid cuts.
    • Collaborate with organizations like NAMI (National Alliance on Mental Illness) to amplify advocacy efforts.

3. Data-Driven Advocacy

  • Strategy: Use data to demonstrate the critical role of Medicaid funding in supporting behavioral health and homelessness services.
  • Implementation:
    • Develop a comprehensive report that highlights the financial impact of Medicaid cuts on local programs, including projected service reductions and community outcomes.
    • Share success stories, such as the operational success of the Crisis Stabilization Unit (CSU) and the Crestwood Healing Center, to showcase the positive impact of Medicaid-funded initiatives.

4. Legislative Advocacy

  • Strategy: Advocate for state and federal policy changes to protect Medicaid funding.
  • Implementation:
    • Organize meetings with state and federal legislators to discuss the local impact of Medicaid cuts and propose solutions.
    • Mobilize community members to contact their representatives and express their concerns about funding reductions.
    • Partner with other counties facing similar challenges to form a coalition and advocate for Medicaid funding at the state and federal levels.

5. Strategic Use of Local Funding

  • Strategy: Optimize the use of local funding sources, such as Measure O, to mitigate the impact of Medicaid cuts while advocating for long-term solutions.
  • Implementation:
    • Allocate Measure O funds strategically to support programs most at risk due to Medicaid cuts.
    • Ensure transparent processes for the $10 million Notice of Funding Availability (NOFA) to maximize its impact on struggling programs.

6. Mobilizing Public Support

  • Strategy: Build a grassroots movement to rally public support for Medicaid funding.
  • Implementation:
    • Organize rallies, petitions, and letter-writing campaigns to demonstrate widespread community opposition to Medicaid cuts.
    • Encourage local businesses and community leaders to publicly endorse the importance of Medicaid funding.

7. Leveraging Media and Storytelling

  • Strategy: Use media and storytelling to highlight the human impact of Medicaid cuts.
  • Implementation:
    • Share personal stories of individuals who have benefited from Medicaid-funded services through videos, articles, and social media.
    • Partner with local journalists to cover the issue and raise awareness.

Conclusion

These advocacy strategies aim to address the challenges posed by Medicaid cuts by mobilizing community support, leveraging data, and engaging with policymakers. By combining grassroots efforts with strategic partnerships and transparent funding processes, Sonoma County can strengthen its case for sustaining Medicaid funding and protecting vital health programs.

What can I help with next?
List pros and cons of current advocacy approaches
Explain Medicaid funding mechanisms and their local impact

List pros and cons of current advocacy approaches

Based on the document, here are the pros and cons of the current advocacy approaches for sustaining Medicaid funding in Sonoma County:

Pros of Current Advocacy Approaches

  1. Proactive Funding Initiatives:
    • The release of the $10 million Notice of Funding Availability (NOFA) demonstrates a proactive effort to support programs facing funding losses. This initiative provides immediate relief to struggling behavioral health and homelessness services.
  2. Strategic Partnerships:
    • The establishment of a new ad hoc committee, including key supervisors, aims to enhance collaboration with partners and ensure transparent allocation of Measure O funds. This approach fosters accountability and strengthens relationships with stakeholders.
  3. Community Engagement:
    • Plans to inform community groups, mayors, and councils about Measure O’s impact and financial challenges show a commitment to transparency and public involvement. This can help build trust and mobilize support for advocacy efforts.
  4. Focus on Data-Driven Solutions:
    • The development of a proposal for a second psychiatric health facility highlights the county’s focus on using data to address service gaps and reduce costs associated with private hospital placements.
  5. Leadership and Expertise:
    • The recommendation to appoint Marc, a former board chair of NAMI, to the “lived experience” seat on the Board of Supervisors ensures that advocacy efforts are informed by individuals with firsthand knowledge of behavioral health challenges.
  6. Operational Success Stories:
    • Highlighting achievements like the operational success of the Crisis Stabilization Unit (CSU) and the Crestwood Healing Center provides evidence of the positive impact of Medicaid-funded programs, strengthening the case for sustained funding.

Cons of Current Advocacy Approaches

  1. Limited Funding Sources:
    • The county’s reliance on Measure O and dwindling Realignment funds creates a precarious financial situation. These local funding sources may not be sufficient to address the growing needs caused by Medicaid cuts.
  2. Uncertainty in Federal Funding:
    • The anticipated “seismic shift” in Medicaid/Medi-Cal funding creates a significant challenge for long-term planning and sustainability of health programs.
  3. Delayed Projects:
    • The stalled mental health unit at the county jail highlights the difficulty of securing adequate funding for critical infrastructure projects, which could undermine advocacy efforts.
  4. Leadership Transition:
    • The ongoing search for interim and permanent leaders for the homeless services team may delay the implementation of advocacy strategies and hinder progress in addressing funding challenges.
  5. Potential Misalignment of Priorities:
    • The strategic pivot to focus on residents with higher behavioral health needs may leave other vulnerable populations underserved, potentially creating gaps in service delivery.
  6. Dependence on Community Support:
    • While community engagement is a positive step, it requires significant effort and resources to mobilize public support effectively. There is also a risk that public advocacy may not yield immediate results in influencing federal funding decisions.

Conclusion

The current advocacy approaches in Sonoma County have several strengths, including proactive funding initiatives, strategic partnerships, and a focus on data-driven solutions. However, they face challenges such as financial uncertainty, leadership transitions, and potential gaps in service delivery. Addressing these cons will require innovative strategies, increased collaboration, and sustained efforts to secure additional funding and support.

What can I help with next?
Explain Medicaid funding mechanisms and their local impact
Draft a policy brief on Medicaid cuts for local officials

Explain Medicaid funding mechanisms and their local impact

Medicaid funding mechanisms and their local impact in Sonoma County are discussed in the document, particularly in the context of behavioral health and homelessness services. Below is an explanation based on the document:

Medicaid Funding Mechanisms

Medicaid is a federal and state program that provides health coverage to eligible low-income individuals. Funding for Medicaid is shared between the federal government and state governments, with the federal government matching a percentage of state expenditures. In California, Medicaid is known as Medi-Cal, and it plays a critical role in funding healthcare services, including behavioral health and homelessness programs.

Key Features of Medicaid/Medi-Cal Funding:

  1. Federal Matching Funds:
    • The federal government matches state spending on Medicaid services, with the match rate varying based on state-specific factors.
    • Cuts to federal Medicaid funding directly reduce the resources available for state programs, creating financial strain.
  2. Reimbursement Model:
    • Medi-Cal operates on a reimbursement basis, meaning providers deliver services and then receive payment from the program. This model is crucial for sustaining services like mental health care and crisis intervention.
  3. Targeted Populations:
    • Medicaid funding is designed to support vulnerable populations, including low-income individuals, children, pregnant women, elderly adults, and people with disabilities. In Sonoma County, this includes residents with higher behavioral health needs and those experiencing homelessness.

Local Impact of Medicaid Funding

Medicaid funding is a cornerstone of Sonoma County’s ability to provide essential health services. The document highlights several ways in which Medicaid cuts could impact local programs:

  1. Financial Strain:
    • Federal Medicaid cuts are described as a “seismic shift” in healthcare funding, creating significant financial uncertainty for Sonoma County. This could lead to reduced funding for critical programs that rely heavily on Medi-Cal reimbursements.
  2. Threat to Behavioral Health Services:
    • Programs like the Crisis Stabilization Unit (CSU) and the Crestwood Healing Center, which are currently operational and effective, depend on Medicaid funding. Cuts could jeopardize their ability to continue providing services.
  3. Impact on Homelessness Services:
    • The county is reorganizing its homelessness team into the behavioral health department to leverage Medi-Cal billing and improve service integration. However, Medicaid cuts could undermine these efforts by reducing the available funding for Medi-Cal services.
  4. Pressure on Local Funding Sources:
    • With federal Medicaid cuts, local funding sources like Measure O and the Realignment fund are under increased pressure to fill the gap. However, these funds are already dwindling, with Measure O’s projected ending balance of $7.1 million causing concern.
  5. Delayed Projects:
    • The planned mental health unit at the county jail is stalled due to insufficient funding. Medicaid cuts could further delay or cancel similar projects, impacting the county’s ability to expand services.
  6. Increased Costs for Private Services:
    • Without adequate Medicaid funding, the county may need to rely more on private hospital placements, which are more expensive and less sustainable in the long term.

Conclusion

Medicaid funding is a critical component of Sonoma County’s health programs, particularly for behavioral health and homelessness services. Cuts to this funding would have far-reaching consequences, including financial strain, reduced service availability, and increased pressure on local funding sources. The county is taking steps to address these challenges, but the long-term impact of Medicaid cuts remains a significant concern.

What can I help with next?
Analyze potential effects of funding cuts on homelessness services
Draft a policy brief on Medicaid cuts for local officials

Analyze potential effects of funding cuts on homelessness services

The document provides detailed insights into the potential effects of funding cuts, particularly federal Medicaid reductions, on homelessness services in Sonoma County. Below is an analysis of these impacts:

1. Financial Strain on Homelessness Programs

  • Impact: Federal Medicaid cuts are described as a “seismic shift” in healthcare funding, which could severely affect the financial stability of homelessness services. Many homeless and housing providers are already in urgent need of financial support to sustain their operations.
  • Example: The county has released a $10 million Notice of Funding Availability (NOFA) titled “Behavioral Health and Homelessness Pathways to Sustainability” to support programs facing funding loss. However, this is a temporary measure and may not address long-term funding gaps.

2. Increased Pressure on Local Funding Sources

  • Impact: With Medicaid cuts, local funding sources like Measure O and the Realignment fund will face increased pressure to fill the gap. However, these funds are already dwindling, with Measure O’s projected ending balance of $7.1 million causing concern among leadership.
  • Example: Measure O currently funds 58.33 employees who provide essential mental health and crisis services. Any reduction in funding could jeopardize these positions and the services they deliver.

3. Risk of Service Reductions

  • Impact: Homelessness services may need to scale back due to insufficient funding, leaving vulnerable populations without access to critical support. This could lead to an increase in homelessness and associated social issues.
  • Example: The county is planning to reorganize its homelessness team under the behavioral health department to leverage Medi-Cal billing and improve service integration. However, Medicaid cuts could undermine these efforts, making it difficult to sustain or expand services.

4. Delayed or Canceled Projects

  • Impact: Funding cuts could delay or cancel planned projects aimed at addressing homelessness and behavioral health needs.
  • Example: The planned mental health unit at the county jail is already stalled due to insufficient funding. Medicaid cuts could further hinder the county’s ability to complete such projects, which are critical for addressing the needs of homeless individuals with behavioral health challenges.

5. Shift in Service Priorities

  • Impact: The county is pivoting its homelessness services to focus on residents with higher behavioral health needs. While this is a strategic adjustment to address the most vulnerable populations, it may leave other homeless individuals without adequate support.
  • Example: The reorganization of the homelessness team into the behavioral health department is intended to improve service integration and leverage Medi-Cal billing. However, this shift may require additional resources that are at risk due to funding cuts.

6. Increased Reliance on Private Services

  • Impact: Without adequate Medicaid funding, the county may need to rely more on private hospital placements for individuals experiencing homelessness and severe behavioral health issues. This approach is more expensive and less sustainable in the long term.
  • Example: The county is developing a proposal for a second psychiatric health facility to reduce costs associated with private hospital placements, but funding cuts could jeopardize this plan.

7. Leadership and Operational Challenges

  • Impact: The county’s homeless services unit is undergoing a leadership transition, which may delay the implementation of strategies to address funding challenges. This could further exacerbate the impact of Medicaid cuts on homelessness services.
  • Example: The search for interim and permanent leaders for the homeless services team is actively underway, but the lack of stable leadership could hinder progress.

Conclusion

Medicaid funding cuts pose a significant threat to homelessness services in Sonoma County. The financial strain, risk of service reductions, delayed projects, and increased reliance on local funding sources could lead to a decline in the availability and quality of services for vulnerable populations. While the county is taking steps to mitigate these impacts, such as releasing the $10 million NOFA and reorganizing services, the long-term sustainability of homelessness programs remains uncertain without additional funding or policy changes.

What can I help with next?
Explain strategies to mitigate funding cuts impact on homelessness services
Compare Sonoma County’s approach with other counties facing Medicaid cuts

Explain strategies to mitigate funding cuts impact on homelessness services

The document outlines several strategies that Sonoma County is implementing or could consider to mitigate the impact of Medicaid funding cuts on homelessness services. Below is a detailed explanation of these strategies:

1. Strategic Allocation of Local Funding

  • Strategy: Optimize the use of local funding sources, such as Measure O and the $10 million Notice of Funding Availability (NOFA), to support homelessness services.
  • Implementation:
    • Direct more funds from the $10 million NOFA toward struggling homeless and housing providers.
    • Ensure transparent processes for NOFA allocation to maximize its impact and build trust among stakeholders.
    • Prioritize funding for programs that address the most critical needs, such as behavioral health services for homeless individuals.

2. Service Integration

  • Strategy: Reorganize the homelessness team under the behavioral health department to improve service integration and leverage Medi-Cal billing.
  • Implementation:
    • Focus on residents with higher behavioral health needs to ensure that resources are directed toward the most vulnerable populations.
    • Streamline operations and reduce administrative costs by consolidating services under one department.

3. Community Engagement and Advocacy

  • Strategy: Build public and stakeholder support for homelessness services through community engagement and advocacy.
  • Implementation:
    • Inform community groups, mayors, and councils about the impact of Measure O and the financial challenges ahead.
    • Mobilize public support for Medicaid funding through town hall meetings, social media campaigns, and partnerships with local organizations.

4. Development of Cost-Effective Solutions

  • Strategy: Invest in cost-effective alternatives to reduce reliance on expensive private services.
  • Implementation:
    • Develop a data-driven proposal for a second psychiatric health facility to reduce costs associated with private hospital placements.
    • Explore innovative housing solutions, such as transitional housing programs, to provide affordable and sustainable options for homeless individuals.

5. Strengthening Leadership and Collaboration

  • Strategy: Ensure strong leadership and collaboration to navigate funding challenges effectively.
  • Implementation:
    • Appoint experienced leaders, such as Marc (former board chair of NAMI), to key positions to bring expertise and lived experience to decision-making.
    • Continue monthly meetings with the new ad hoc committee to align on strategic priorities and ensure accountability in funding allocation.

6. Leveraging Data for Decision-Making

  • Strategy: Use data to identify service gaps and prioritize funding for programs with the highest impact.
  • Implementation:
    • Conduct a comprehensive analysis of homelessness services to determine areas of greatest need.
    • Use data to advocate for additional funding and demonstrate the effectiveness of existing programs.

7. Exploring Alternative Funding Sources

  • Strategy: Identify and secure alternative funding sources to supplement Medicaid and local funds.
  • Implementation:
    • Apply for state and federal grants targeted at homelessness and behavioral health services.
    • Partner with private organizations and philanthropic groups to secure additional funding.
    • Explore public-private partnerships to fund innovative solutions for homelessness.

Conclusion

Sonoma County is already taking steps to mitigate the impact of Medicaid cuts on homelessness services, such as releasing the $10 million NOFA and reorganizing services. However, additional strategies, including optimizing local funding, strengthening leadership, leveraging data, and exploring alternative funding sources, will be critical to ensuring the sustainability of these vital programs. By combining these approaches, the county can better address the challenges posed by funding cuts and continue to support its vulnerable populations.

What can I help with next?
Generate talking points for community advocacy on Medicaid funding
Explain strategies to mitigate funding cuts impact on homelessness services

Generate talking points for community advocacy on Medicaid funding

Based on the document, here are talking points for community advocacy on Medicaid funding in Sonoma County:

Talking Points for Community Advocacy

1. Highlight the Importance of Medicaid Funding

  • Medicaid/Medi-Cal is a lifeline for vulnerable populations, including individuals experiencing homelessness and those with behavioral health needs.
  • Federal Medicaid funding supports essential services like mental health care, crisis intervention, and housing assistance, which are critical for community well-being.

2. Emphasize the Local Impact of Medicaid Cuts

  • Federal Medicaid cuts are expected to create a “seismic shift” in healthcare funding, leading to financial uncertainty for Sonoma County’s health programs.
  • Many homeless and housing providers are already in urgent need of financial support, and Medicaid cuts could force them to reduce services or shut down entirely.
  • The county’s Realignment fund balance is dwindling, and Measure O’s projected ending balance of $7.1 million may not be sufficient to fill the gap left by Medicaid cuts.

3. Showcase Success Stories

  • Share examples of programs that have thrived due to Medicaid funding, such as:
    • The Crisis Stabilization Unit (CSU), which is now fully operational and providing critical mental health services.
    • The Crestwood Healing Center, a 16-bed psychiatric health facility that has reduced reliance on expensive private hospitals.
  • These programs demonstrate the tangible benefits of Medicaid funding and the risks of losing it.

4. Advocate for Transparency and Collaboration

  • Stress the importance of transparent processes for allocating local funds, such as the $10 million NOFA, to ensure that resources are directed to the programs most in need.
  • Encourage community members to support the county’s efforts to reorganize services and enhance collaboration with partners to improve efficiency and service delivery.

5. Mobilize Public Support

  • Urge community members to contact their local, state, and federal representatives to express their concerns about Medicaid cuts.
  • Organize public forums, rallies, and letter-writing campaigns to demonstrate widespread opposition to funding reductions.

6. Call for Alternative Funding Solutions

  • Advocate for the exploration of alternative funding sources, such as state and federal grants, public-private partnerships, and philanthropic contributions.
  • Highlight the need for innovative solutions, such as transitional housing programs and additional psychiatric health facilities, to address homelessness and behavioral health challenges.

7. Stress the Long-Term Consequences

  • Explain that Medicaid cuts could lead to increased homelessness, higher healthcare costs, and greater strain on local resources.
  • Emphasize that investing in Medicaid funding now will save money in the long term by reducing reliance on expensive private services and preventing crises.

Conclusion

These talking points aim to inform and mobilize the community to advocate for the preservation of Medicaid funding. By emphasizing the importance of Medicaid, showcasing success stories, and highlighting the local impact of funding cuts, Sonoma County can build a strong case for sustained support and encourage action from community members and policymakers.

What can I help with next?

March 3rd, 2026 Agenda – Annual Report/Integrated Plan Committee

The California Brown Act, “shall not be construed as preventing a member of the legislative body from engaging in separate conversations or communications on an internet-based social media platform to answer questions, provide information to the public, or to solicit information from the public regarding a matter that is within the subject matter jurisdiction of the legislative body provided that a majority of the members of the legislative body do not use the internet-based social media platform to discuss among themselves business of a specific nature that is within the subject matter jurisdiction of the legislative body. A member of the legislative body shall not respond directly to any communication on an internet-based social media platform regarding a matter that is within the subject matter jurisdiction of the legislative body that is made, posted, or shared by any other member of the legislative body.”

This post, supplied by Gregory Fearon, a member of the legislative body of the Sonoma County Board of Supervisors (Sonoma County Behavioral Health Board), is provided in support of an agenda topic on a legally-noticed meeting of that legislative body on March 3rd, 2026.

The Specific Powers and Duties of the Sonoma County Behavioral Health Board are:

a. Review and evaluate on the community’s behavioral health needs, services, facilities
and special problems.
b. Review any County agreements entered into pursuant to Section 5650 of the Code or
any subsequent amendments.
c. Advise the Sonoma County Board of Supervisors and the local behavioral health
director as to any aspect of the local behavioral health and substance use disorder
programs.
d. Review and approve the procedures used to ensure citizen and professional
involvement at all stage of the planning process.
e. Submit an annual report to the Sonoma County Board of Supervisors on the needs and
performance of the County’s behavioral health system.
f. Review and make recommendations on applicants for the appointment of a local
director of behavioral health services. The Board shall be included in the selection
process prior to the vote of the Sonoma County Board of Supervisors.
g. Review and comment on the County’s performance outcome data and communicate
it’s findings to the State Behavioral Health Planning Council.
h. Review and assess the impact of the realignment of services from the State to the
County, on services delivered to clients, and on the local community.
i. Any additional duties or authority the Sonoma County Board of Supervisors may
transfer to the Board.

The Sonoma County Behavioral Health Board has established a standing committee known as the “Annual Report/Integrated Plan Committee (AR/IP Committee)” for the purpose of 1) fulfilling its reviewing responsibilities in sections a,b,d,f,g & h; 2) submitting an annual report in compliance with section c; and 3) advising the Sonoma County Board of Supervisors and the local behavioral health director as to any aspect of the local behavioral health and substance use disorder programs.

Agenda Items for the AR/IP Committee are:

1) Review responsibilities associated with the bolded section of our duties:

a. Review and evaluate on the community’s behavioral health needs, services, facilities
and special problems.

b. Review any County agreements entered into pursuant to Section 5650 of the Code or
any subsequent amendments.
c. Advise the Sonoma County Board of Supervisors and the local behavioral health
director as to any aspect of the local behavioral health and substance use disorder
programs.
d. Review and approve the procedures used to ensure citizen and professional
involvement at all stage of the planning process.

e. Submit an annual report to the Sonoma County Board of Supervisors on the needs and
performance of the County’s behavioral health system.
f. Review and make recommendations on applicants for the appointment of a local
director of behavioral health services. The Board shall be included in the selection
process prior to the vote of the Sonoma County Board of Supervisors.
g. Review and comment on the County’s performance outcome data and communicate
it’s findings to the State Behavioral Health Planning Council.

h. Review and assess the impact of the realignment of services from the State to the
County, on services delivered to clients, and on the local community.

i. Any additional duties or authority the Sonoma County Board of Supervisors may
transfer to the Board.

2) Determine the contents, and develop a workplan, for the annual report.

3) Review and discuss the information we have been provided concerning the Draft FY26-29 Integrated Plan.

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.

Sonoma DHS Homeless Revamping Workshop, Oct 23rd

Short Summary

You participated in a feedback session on the county’s new vision for homeless services.

Long Summary

The meeting was called by the Department of Health Services feedback session where new leadership, Nolan Sullivan and Desirae

Olstrom, unveiled a revamped strategy to address homelessness. They proposed a “funnel” system using county facilities to support individuals with high-acuity behavioral health needs. The majority of the meeting was dedicated to gathering your and other partners’ feedback on this new model, identifying systemic gaps, and discussing the need for better collaboration, data transparency, and a unified system of care.

The problem

The Department of Health Services is revamping its homeless services team and seeking feedback on a new vision to improve partnerships and service delivery. The county aims to address its historically siloed approach and open up its resources and processes for better collaboration. The primary focus of the new vision is the segment of the homeless population with high-acuity behavioral health and substance use needs, which is estimated to be 5-10% of the total 1,900 homeless residents. This group is often difficult to serve in traditional programs and can destabilize properties.

Themes discussion

A new “funnel” system was proposed by the county to create a continuum of care for high-acuity individuals. The pathway would move clients through a series of facilities with increasing levels of independence: 

  • Eliza’s Village: The entry point for stabilization.
  • Arrowwood: Single occupancy rooms with more services. 
  • Mickey Zane: Individual apartments to prepare for independent living.

The end goal is to graduate individuals back into the Coordinated Entry (CE) system for Permanent Supportive Housing (PSH).

A major concern raised was the large population that the county’s proposed funnel would not serve, leaving approximately 1,500 individuals for partner agencies to handle. This includes specific hard-to-house groups, such as arson (219) and sex offense (290) registrants, who are often screened out of existing housing options. The need for a single, unified system of care was a recurring theme, emphasizing the need to break down silos between county departments (e.g., Homelessness and Behavioral Health) and external partners. Data transparency and system functionality were highlighted as critical for building trust and enabling effective

collaboration. The current HMIS system is considered limited in its reporting capabilities. Resource constraints and funding limitations for the county, cities, and non-profit providers were an underlying issue throughout the discussion.

Specific ideas

Integrate county behavioral health staff directly with partner agencies and on-site at facilities. This “in-person handoff” is seen as extremely beneficial for navigating clients into services. 

  • Develop a centralized and transparent referral system for providers. This would allow agencies to submit referrals for high-needs clients and track their status. 
  • Provide a higher level of ongoing support for clients once they are in PSH. An Assertive Community Treatment (ACT) model was suggested for individuals who continue to need intensive services after being housed. 
  • Address the challenge of individuals who refuse services or are too ill to engage with support systems. 
  • Streamline the contracting and RFP process to reduce administrative burden. Suggestions included creating multi-year contracts and consolidating various city and county RFPs into a single cycle.

Future directions

  • The county should take on a lead role as a convener to bring together all stakeholders, including shelter providers, tribal entities, and cities, to address system-wide issues. 
  • One immediate project suggested was creating a coordinated emergency weather response plan. 
  • The group should develop a unified advocacy message to state legislators regarding restrictive funding and unfunded mandates.
  • A formal “gap analysis” is needed to inventory all existing services and providers in the county to identify where deficiencies lie.
  • The county will continue to refine its “funnel” model while considering the feedback on excluded populations and operational challenges, such as the remote location of Eliza’s Village. 
  • The county acknowledged the need to improve internal policies, noting they recently implemented a six-month time limit at facilities like Eliza’s Village to ensure client progression.

Measure I Citizens Advisory Council Meeting, Oct 23rd

Short Summary

The group refined and approved funding strategies for early childhood and community health initiatives.  It finalized early childhood support strategies, focusing on community-based care and inclusive language, ending with personal reflections.

Long Summary

The advisory council made final adjustments to strategic language for early childhood funding.  The group meticulously refined the language for early childhood funding strategies, deciding to prioritize local ‘place-based’ organizations and add ‘play-based’ approaches to mental health. It also discussed including license-exempt centers in future compensation models and creating a flexible scholarship model. The discussion emphasized supporting local providers and ensuring service availability before expanding screening.The session concluded with a successful vote to approve the amended strategies and 

reflections on the work’s impact and importance for the community.  The group expressed heartfelt reflections from members on the collaborative process, the importance of the work, and a shared 

sense of accomplishment and gratitude.

Members expressed humility, gratitude, and respect for the collaborative process and the work of early childhood educators.  The group acknowledged the significance of having funding and a community-driven process to support families, which is not a given everywhere.  Appreciation was extended to the staff for preparing materials that enabled detailed and productive conversations.

Review of Progress

The team met to finalize the language and allocations for several key strategies before a formal vote. The team reviewed and finalized funding strategies for a five-year plan, marking a significant milestone from the initial idea phase to an approved plan.  The discussion’s goal was to ensure the intent of the strategies was clearly captured, particularly for the development of future Requests for Proposals (RFPs).  Participants reflected on the progress made, from initial concepts to a voted-upon five-year plan, acknowledging it as a significant accomplishment for the county’s early childhood and health initiatives. Discussion centered on refining the language of the strategies to ensure the intent is clear for the Request for Proposals (RFP) process.  The overall progress was framed as a major accomplishment in supporting the county’s children and families, even while acknowledging that the funding is a “drop in the bucket” compared to the total need.

Key Achievements

The group successfully reached a consensus on several complex language changes after detailed discussion. The council successfully voted on and approved the proposed strategies and allocations with a series of amendments. A motion was passed to approve the strategic plan with all discussed amendments, marking a major milestone, to implement specific language changes across several strategies, finalizing the framework for future funding.

Challenges and Adjustments Needed

Provider Eligibility and Prioritization

A concern was raised about large, external organizations applying for funds instead of local providers who know the community.

It was suggested to explicitly call out both “new and existing service providers” to expand the field while prioritizing local expertise.

Broadening Strategy Language

The term “Family Resource Center” was deemed too restrictive. Several strategic adjustments were made to proposal language to ensure clarity and inclusivity:   Also included was the broader “place-based locations in neighborhoods” to include a wider range of trusted community organizations. The “sliding scale” language for family scholarships was questioned for not accounting for family expenses beyond income. The group moved toward the idea of “developing a model” to allow for more flexibility.

Clarifying Service Types

To ensure mental health services are not purely clinical, language was added to strategy 1A. The phrase “which could include play-based” was inserted after “mental health services” to emphasize the importance of play without being overly prescriptive.The group discussed the need to expand service capacity in tandem with developmental screenings to avoid causing anxiety for families whose children are identified as needing support.There was concern that increasing developmental screenings could cause family anxiety if corresponding intervention services are not available.

Compensation Model for ECE Providers

It was discussed whether legally license-exempt centers “will be considered” when the compensation model is determined, acknowledging the complexity of their full inclusion. The group debated whether legally licensed exempt centers should be “included” or “considered” for the new compensation model. The final decision was to use the language “will be considered when the compensation model is determined” to ensure they are part of the conversation without making a premature commitment.  A future process will be initiated to design the ECE compensation system, which will consider legally licensed exempt centers.

Several strategic adjustments were made to proposal language to ensure clarity and inclusivity: Added the phrase “which could include play-based” to the mental health services strategy to emphasize the importance of play without being overly prescriptive. Removed specific examples like “family literacy programs” to make the strategy for non-traditional early learning programs more general. 

Action Items and Accountability for the Week Ahead

Finalize Strategy 1A Language

Add “which could include play-based” after “mental health services” and before “and nutritional supports.”

Correct Strategy 2A Language

Add the word “and” to correct a grammatical error in the phrase “mobile and pop up clinical.”

Update ECE Strategy 1B

Remove specific program names to broaden the scope, changing the wording to “Invest in and elevate non-traditional early learning programs.”

Implement Approved Changes

Staff is accountable for incorporating all approved amendments into the official strategy documents that will guide the development of RFPs.

California Behavioral Health Planning Council Meeting on June 19, 2025, Housing and Homelessness Committee

Item #2 California Interagency Council on Homelessness (Cal ICH) Action Plan for 2025 – 2027 

Cody Zeger, Director of Statewide Policy at the California Interagency Council on Homelessness (Cal ICH), presented an overview of their 2025-2027 Statewide Action Plan to prevent and end homelessness. Cody began with a brief introduction to Cal ICH, which is responsible for overseeing the implementation of Housing First policies, guidelines, and regulations supported by an advisory committee and a lived-experience advisory board. 

Initially launched in 2020, Cal ICH’s Action Plan aims to coordinate state efforts to address homelessness with a vision of building an equitable and just California where homelessness is rare, brief, and a one-time experience. The 2025-2027 Action Plan focuses on the following five key goals: 

• Help more people leave unsheltered homelessness. 

• Help more people move into housing. 

• Ensure people do not experience homelessness again. 

• Prevent more people from experiencing homelessness. 

• Create more housing. 

Cody also presented the plan’s three-year targets: 

• Move 70% of unsheltered individuals into shelters. 

• Place 60% into permanent housing. 

• Create 1.5 million new housing units with 710,000 designated for low-income residents. 

He described key strategies to meet these goals such as interagency coordination, strategic investments, and equity-centered frameworks to address systemic barriers. Cody highlighted core principles that guide the plan, such as prioritizing racial equity, adopting trauma-informed approaches, and elevating the voices of those with lived experience of homelessness. 

Cody concluded his presentation and opened the floor for questions from committee members. Key topics included: 

• A committee member inquired about the size of the lived experience advisory board. Cody shared that Cal-ICH reduced its membership from 30 to approximately 25 members. Each member serves a two-year term. He explained that the board provides subject matter expertise, reviews key documents, and offers recommendations to Cal ICH members before key decisions. 

• A committee member raised concerns about the proposed 44% federal cuts to the U.S. Department of Housing and Urban Development (HUD), particularly their impact on project-based and tenant-based rental assistance. Cody acknowledged the risk, noting that 15,000 emergency housing vouchers are slated to expire. 

• A committee member asked how the number of homeless individuals aligns with the projected housing units. Cody explained that the 2.5 million planned units, including 1.5 million by 2027 and 710,000 reserved for low-income residents, are part of a broader housing strategy and not specifically designated for the homeless population. 

• A committee member asked how racial equity is reflected in the plan’s goals and data analysis. Cody emphasized Cal ICH’s commitment to disaggregating targets by race, ethnicity, and gender to ensure a more inclusive and equitable approach. 

• When asked about Cal ICH’s leverage in advancing the Action Plan, Cody described their statutory authority and stressed the importance of cross-agency relationships. He noted that their influence stems from formal power and their ability to communicate and coordinate across state departments. 

Public Comment: 

Paula, a member of the public, inquired about current data reflecting progress toward the plan’s three-year goal of a 42% increase in housing placements. Cody directed her to Cal ICH’s website, where quarterly updates provide the latest information. He noted that the most recent data covers the calendar year 2024. 

Barbara Wilson from Los Angeles County raised a question about tracking individuals moving from hospital settings to residential facilities, particularly those with psychosis. She was concerned about how these transitions are captured and whether individuals lose housing access once in licensed facilities. 

Council Member John Black emphasized the importance of early intervention, proposing the use of peer support workers to help individuals who are newly experiencing homelessness before their situation worsens. 

Item #3 Perspectives on Recovery Housing Panel Discussion 

Over the past two quarterly meetings, the Housing and Homelessness Committee engaged in discussions about recovery housing and the Housing First model. The discussions focused on their roles within behavioral health services and highlighted key challenges and best practices. This panel built on those discussions and provided first-hand insights to inform the Committee’s work further. 

The panel featured three distinguished speakers with lived experiences of addiction and homelessness: 

• Elizabeth Colorado, Advocate for the Unhoused Community 

• Claudine Sipili, Lived Experience & Innovation Director, Destination Home 

• Anna Kokanyan, Director of Admissions & Program Director, Conquer Recovery Centers 

Each panelist shared their personal story of how recovery housing played a pivotal role in their journey to stability and long-term recovery. They addressed the barriers often faced during transitions from homelessness and addiction to stable housing, including financial hardship, limited guidance, and systemic obstacles. Their experiences highlighted the need for compassionate, structured environments that foster connection and provide resources without rigid requirements. 

The panelists called for more flexible, trauma-informed approaches that prioritize human dignity, autonomy, and choice. Claudine emphasized the need to advocate for policies that center racial equity and incorporate lived expertise. She also stressed that recovery housing should remain voluntary and not a requirement. Anna emphasized the need to validate individuals’ feelings and provide care in safe and supportive settings. Elizabeth highlighted the need to meet people where they are and guide them through both recovery and permanent housing pathways. 

The panelists expressed their gratitude for the opportunity to share their experiences. The discussion concluded with a Questions-and-Answers session with committee members. Key topics included: 

• A committee member asked Anna about the duration of her program at Conquer Recovery Centers and why participants travel from out of town. Anna explained that many public facilities have waitlists of six to nine months. Her program, which accepts private insurance, provides more immediate access to treatment. 

• A committee member celebrated Anna’s recent acceptance into a college program and shared heartfelt reflections on her journey. They emphasized the value of lived experience, resilience, and personal growth. 

• Another member raised concerns about the decision to offer housing before addressing mental health and substance use needs. The panelists acknowledged the diverse perspectives on the Housing First model and emphasized that services must reflect individual needs and allow each person to guide their own recovery. 

• When asked how they remain strong and grounded in their work, the panelists shared personal wellness practices. Anna spoke about the importance of caring for the mind, body, and spirit through exercise, prayer, meditation, a healthy diet, and therapy. Claudine described her connection with nature through off-road travel as a source of peace, reflection, and spiritual strength. Elizabeth emphasized simple acts of kindness to give back and stay rooted in empathy and purpose. 

• A committee member offered encouragement and shared a personal story about how they helped an individual regain custody of her children. The story affirmed the power of persistence, compassion, and hope. 

Public Comment: 

Barbara Wilson expressed appreciation for the panel discussion and proposed the creation of a safe healing space for individuals with behavioral health challenges. She shared that, in her experience, every unhoused person she had worked with could successfully maintain housing. Barbara also raised concerns about the Housing First model, noting that some individuals struggle with its structure and may feel like failures when they must return to more supported environments. Additionally, she questioned defining success solely in terms of paid employment, emphasizing that mental health conditions can impact a person’s ability to work. 

Anna, a college student, shared how impactful it was to hear directly from individuals with lived experience. While she studied incarceration and homelessness in her coursework, she said the personal stories gave her a deeper and more meaningful understanding of the issues. 

A committee member highlighted the challenges of treating individuals who use substances. She acknowledged the value of harm reduction but emphasized that trauma work remains difficult when a person remains under the influence. 

Item #4 Cal ICH and Recovery Housing Panel Debrief Discussion 

The Committee debriefed on the information presented by Cody Zeger from the California Interagency Council on Homelessness (Cal ICH) and the panelists from the Recovery Housing Panel. Committee members also discussed potential next steps. 

A committee member expressed deep appreciation for the lived expertise shared by the panelists. She emphasized the value of hearing from individuals who have experienced addiction and homelessness, are now in recovery, and are helping others through successful programs. She encouraged the inclusion of similar presentations in future meetings. Another committee member outlined the following follow-up items in response to the presentation from the California Interagency Council on Homelessness (Cal ICH): 

• Federal Housing Voucher Concerns: Urged follow-up with Cal ICH about federal funding cuts and reduced availability of rental vouchers. She noted that the presentation addressed only Homeless Prevention vouchers, which make up a small portion of the total supply. In Monterey County, she reported that no new Tenant-Based Vouchers appear available, and Project-Based Vouchers remain unavailable, which has stalled progress for individuals on waitlists. 

• Support for Undocumented Populations: Requested information on Cal ICH’s strategy to support undocumented individuals. The committee member shared that 13.5% of her county’s population are undocumented and many in this group experience homelessness. She shared that local shelters have reached capacity and often house undocumented families for extended periods, which forces others in need of emergency shelter to go without. She urged the Committee to seek state-level guidance and data on this growing concern. 

The committee member raised concerns about the long-term effectiveness of six-month rapid rehousing programs. She explained that individuals with serious mental illness who are unemployed often do not meet eligibility requirements for these short-term services. Even among those who do qualify, many are unable to sustain rent payments once the assistance ends. In one local case, 90% of participants became homeless again after the six-month support period. She questioned whether this approach offers a sustainable solution. 

A committee member added that shelters should function as gateways to permanent housing, not long-term temporary accommodations. While acknowledging the value of recovery housing, he stressed that it is just one piece of a broader housing continuum that requires support. 

Another committee member emphasized the importance of homelessness prevention. She referenced research from the University of California, San Francisco, showing that many people become homeless after missing a single rent or mortgage payment. She questioned why state and national investments remain focused on rehousing rather than proactively preventing housing loss. She also acknowledged the efforts of one panelist whose organization is working effectively in the prevention space. 

A committee member described the current moment as a pivotal opportunity to advance the Committee’s advocacy efforts. He noted that, although the presenter outlined several strategic goals, homelessness prevention remained undefined. He emphasized the value this Committee brings, as members provide firsthand insight into effective prevention strategies. The committee member added that the collective effort of this Committee could help influence broader policy decisions and bring hope to individuals at risk of homelessness. 

Public Comment: 

Barbara Wilson expressed appreciation for the Committee’s longstanding work, recalling her early involvement when she raised concerns about the closure of licensed adult residential facilities due to low reimbursement rates. She also highlighted the gap in oversight for sober living homes, which are unlicensed and therefore not subject to consistent standards. Barbara noted she has been in dialogue with her county’s Sober Living Council and referenced similar efforts in Santa Clara County to establish operational guidelines for these homes. 

She emphasized the lack of communication between systems and that many individuals’ experiencing homelessness are unaware of licensed residential options. In contrast, mental health providers often lack insight into the realities of homelessness. Barbara stressed the urgency to break down these silos, particularly due to recent resistance from the substance use community during a Los Angeles County town hall meeting, where concerns were raised about merging mental health and substance use systems. 

Action/Resolution 

Committee staff will follow up with the questions to the California Interagency Council on Homelessness (Cal ICH). 

Responsible for Action-Due Date 

Simon Vue – April 2025 

Item #5 Proposition 1 Update 

Council staff, Simon Vue, shared an update on Proposition 1 Bond Behavioral Health Continuum Infrastructure Program (BHCIP) Round 1: Launch Ready. 

On May 12, 2025, the Department of Health Care Services (DHCS) announced Proposition 1 BHCIP Round 1: Launch Ready awards. Eligible organizations applied for funding to construct, acquire, and rehabilitate properties for behavioral health services for Medi-Cal members. The Department awarded 124 projects across 214 behavioral health facilities in California to support: 

• 5,077 new residential/inpatient treatment beds for mental health and substance use disorders. 

• 21,882 new outpatient treatment slots. 

Additionally, the Department is preparing to launch BHCIP Round 2: Unmet Needs in May 2025, which will provide up to $1 billion in competitive funding awards. 

This funding is a vital part of the Department’s Behavioral Health Transformation efforts, which aim to strengthen California’s approach to providing services for mental health and substance use disorders by focusing on community-based care and support. Although the Behavioral Health Continuum Infrastructure Program (BHCIP) is not part of Proposition 1, the measure allocates up to $4.4 billion through the Behavioral Health Infrastructure Bond Act (BHIBA), which establishes the program as a key vehicle to expand California’s behavioral health infrastructure. This funding supports the development of treatment facilities, including residential care settings and supportive housing. The Department distributes these funds through competitive grants, focusing on community-based services and regional projects. 

Action/Resolution 

Staff will continue to monitor for the May updates regarding the Bond Behavioral Health Continuum Infrastructure Program Round 2: Unmet Needs. 

Responsible for Action-Due Date 

Simon Vue – May 2025