Tag: mental-health

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?

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 

Sonoma County Behavioral Health Board Meeting on Oct 21st

Short Summary of a presentation at the Sonoma County Behavioral Health Board meeting on 10/21/25

A review of California’s mental health data to address care disparities and improve community access.

Long Summary

The Board heard a presentation on mental health service disparities in California, using a CalMHSA data dashboard. The discussion highlighted challenges with data inconsistencies and access to care in Sonoma County, particularly for Asian, Pacific Islander, and native communities due to stigma and language barriers. The conversation also covered funding strategies, community outreach, and a call for more personal stories to better illustrate how individuals navigate the mental health system.

Data Analysis and Disparities

The California Mental Health Services Authority (CalMHSA) created a data dashboard to compare mental health measures across California’s 58 counties. According to 2023 data from the CalMHSA workbook, Sonoma County is performing poorly on the “access to care” measure. The data is based on claims submitted by the county to the state. Disparities in care were identified across different demographic groups and ethnicities. Data for small populations, such as Asian, Pacific Islander, Alaskan Native, and American Indian communities, is sometimes suppressed, making analysis difficult.

Access to Care Challenges

The county’s rate for access to care is below the statewide average, based on 2020-2021 data. Specific groups show very low service penetration rates: Alaskan Natives have a rate of 1.7%. Asian or Pacific Islanders have the lowest rate at 1%. Barriers to accessing care include: Cultural stigma around mental health treatment, especially within Asian Pacific Islander communities. Language barriers, such as a lack of Spanish-speaking staff at service locations.

Strategies and Funding

Best practices to support BIPOC communities are being implemented: Coordinated specialty care for individuals experiencing a first episode of psychosis. Community outreach events to inform residents about available services. Funding to address access to care goals will primarily come from: Behavioral health services and supports.

Full-service partnerships.

State-level funding from Prop 1 is allocated for workforce training and development, and the state is seeking local input on its use. A contractor provides support for staff in crisis situations, such as those on the mobile support team and at the crisis stabilization unit.

Patient Pathways

A request was made for more concrete examples of an individual’s journey through the mental health system. Three primary pathways for accessing care were outlined:  Through an individual’s private insurance. By contacting the county’s access teams, which serve as the “front door” to services. It was suggested that a future meeting could feature individual stories to better illustrate how the system works on a personal level.

Short Summary of Sonoma County Behavioral Health Board Meeting on 10/21/25

The meeting began with a discussion about fixing communication issues.

Long Summary

Significant frustration was expressed regarding poor communication and the difficult onboarding process for new members. The group discussed proposals to improve orientation and to be more involved in vetting new recruits, highlighting a clear disconnect with the appointing authority.

Review of Progress

The Chair’s report was noted as being brief. The board reviewed current vacancies by district:

District 3: One vacancy. District 4: Two vacancies. District 5: Two vacancies.

Key Achievements

The board website has been updated. All new members and the latest minutes are now available on the website.

Challenges and Adjustments Needed

Significant frustration was expressed regarding the lack of communication and support for new board members. New members reported confusion over meeting schedules, specifically regarding a canceled August meeting that was then held. There have been difficulties with basic orientation, such as obtaining name tags and understanding procedures. A systemic issue was identified with the board’s inability to meet with prospective members before their appointment.  The board feels this prevents them from setting clear expectations and providing a proper orientation. There is a conflict with a higher authority regarding the board’s role in the member appointment process, with the board feeling they are being excluded.

Action Items and Accountability for the Week Ahead

A member will contact ISD to correct a website error where a former co-chair is still listed. A motion was made and seconded to take formal action to address the board’s lack of involvement in the member appointment process.  It was suggested that the group co-sign and send a letter to the County Board of Supervisors. The letter would advocate for the board’s involvement in recruiting and orienting prospective members.

Board Communication and Onboarding Issues

Board members expressed significant frustration over systemic communication failures. New members reported not receiving notifications for meetings, leading to confusion and missed sessions.  Onboarding processes are lacking, with members struggling to get name tags or find sign-in sheets.

The board website had outdated information and was missing meeting minutes, though steps are being taken to resolve this with the IT department.  A strong desire was voiced for the board to participate in the recruitment and orientation of new members to set expectations early.  A consensus was reached to communicate again with the Board of Supervisors to assert their role in the appointment process, which is currently a point of contention.

Meeting Logistics and Technology

A discussion was held on whether to hold meetings in a consistent central location or rotate them through different geographical areas to engage local communities. Recurring technology failures, including issues with Wi-Fi and audio during the current meeting, highlighted the need for a reliable setup. A motion passed to adopt a hybrid approach:  Meetings will be held at a consistent, central location with robust technology for a reliable Zoom presence. Presentations will be varied by geographical area to ensure all parts of the county are represented. The November meeting will be held at 1450 Neotomas, a location with superior audiovisual capabilities.

Vice-Chair Election

After a previously nominated candidate resigned, a new election was held for the Vice-Chair position. Alexandra and Angelina were nominated as candidates. Following a vote, Alexandra was officially elected as the new Vice-Chair.

Behavioral Health Services Act (BHSA) Overview

A presentation detailed the transition from the Mental Health Services Act (MHSA) to the Behavioral Health Services Act (BHSA).  The key difference is that BHSA is broader, officially including substance use disorders alongside mental health.  Under MHSA, funds could not be used to treat someone with only a substance use disorder. The BHSA prioritizes services for the most vulnerable individuals.

BHSA Program and Funding Allocation

Sonoma County expects to receive approximately $38 million in annual BHSA funds for the upcoming three-year plan.  Funding is divided into several main categories:

Housing (30% / $11.4M):  Half of these funds must be dedicated to serving the chronically homeless. Will be used for rental subsidies, vouchers, deposits, and utility bills.

Full-Service Partnerships (FSP) (35%):

Mandated programs for four age groups: children/youth, transitional-aged youth (18-25), adults, and older adults.  Will continue specialty programs like Forensic Assertive Community Treatment (FACT).

Early Intervention & Prevention (51% of population-based funds):

Programs include the Youth Access Team, First Episode Psychosis treatment, Wraparound services for foster youth, and the Suicide Prevention Hotline.

The Integrated Plan

Counties are now required to submit a unified, three-year “integrated plan” for all behavioral health services. The Department of Healthcare Services (DHCS) has created a standardized template that all counties will use for this plan.  The plan must account for all behavioral health funding streams, not just BHSA funds. It must address six state-mandated goals, including improving access to care and reducing homelessness, institutionalization, and justice involvement.  Sonoma County has chosen to add suicide prevention as a seventh local goal due to higher-than-average rates in the area.

Measure O Meeting on August 20th

Short Summary of a meeting of the Measure O Oversight Committee on August 20th

County officials discussed severe funding cuts impacting behavioral health and homelessness services,highlighting critical financial challenges.

Long Summary

The conversation delved into the precarious financial state of Sonoma County’s behavioral health and homelessness services. You heard about federal Medicaid cuts, dwindling local funds, and the critical role of Measure O. Officials expressed nervousness about future reductions, the difficulty in predicting impacts, and the need for tough decisions, strategic partnerships, and community advocacy to maintain vital services amidst a “seismic shift” in healthcare funding.

Announcements

A $10 million Notice of Funding Availability (NOFA), titled “Behavioral Health and Homelessness Pathways to Sustainability,” has been released to support existing programs facing funding loss.  The deadline for proposals is September 17th, with a pre-bid conference scheduled for the following day.  Marc, the former board chair of NAMI, is recommended to fill the vacant “lived experience” seat.  His appointment will go to the Board of Supervisors for official approval on September 3rd. A new ad hoc committee, including Supervisor Gore and Supervisor Coursey, has been established to oversee Measure O funding and enhance collaboration with partners.  The county’s homeless services unit is undergoing a leadership transition, with a plan to reorganize the team under the behavioral health department.

Key Achievements

The Crisis Stabilization Unit (CSU) has successfully addressed staffing shortages and is now almost fully staffed and operational.  A successful QPR (Question, Persuade, Refer) suicide prevention training was delivered to counselors at Analy High School, increasing their confidence in addressing suicidal ideation.  The Crestwood Healing Center, a 16-bed psychiatric health facility, is running effectively and has become a significant asset, reducing reliance on private hospitals. Measure O currently funds 58.33 employees who are delivering essential mental health and crisis services across the county.

Challenges and Adjustments Needed

Financial Uncertainty: The most significant challenge is the looming fiscal crisis due to anticipated federal cuts to Medicaid/Medi-Cal, described as a “seismic shift” in healthcare funding.  The county’s Realignment fund balance is dwindling, and the projected Measure O ending balance of $7.1 million is causing significant concern among leadership.

Project and Funding Gaps:

The planned mental health unit at the county jail is stalled because the allocated $39 million is insufficient for current construction costs, and the state has not allowed for plan lterations. Many homeless and housing providers are in urgent need of financial support to sustain their operations.

Strategic Adjustments:

A reorganization is planned to move the homelessness team into the behavioral health department to leverage Medi-Cal billing and improve service integration.  A strategic pivot is underway for homeless services to focus on residents with higher behavioral health needs.  An allocation adjustment for the $10 million NOFA may be requested to direct more funds toward struggling homeless and housing providers.

Action Items and Accountability for the Week Ahead

The team will continue developing a data-driven proposal for a second psychiatric health facility to further reduce costs associated with private hospital placements.  The leadership will continue its monthly meetings with the new ad hoc committee to provide updates on. Measure O and align on strategic priorities, including the preference for transparent NOFA processes. A plan is being formulated to “take the show on the road” to proactively inform community groups, mayors, and councils about Measure O’s impact and the upcoming financial challenges.  The search for an interim and permanent leader for the homeless services team is actively underway.

Behavioral Health Board

Recommendations to the Behavioral Health Board – July 15th Meeting in Guerneville, 5-7pm, Russian River Resiliency Center, 16385 First Street.

  1. Schedule Bi-Monthly Open Comment periods for the FY 26-29 Behavioral Health Integrated Plan, in September, November, January, March, and June.

Over the last month, the Behavioral Health Director and I have communicated concerning important Executive Committee recommendations about publishing recent behavioral health reports, guidelines, and the draft plan.  The result is that, soon, the public will be able to find those reports and guidelines on the Department’s website. Their remaining decision, included in our recommendations, is to place the draft Integrated Plan, on the Department website in Open Comment Periods between now and the State submission deadline.

Motion: To advise the Department of Health Services and the Sonoma County Board of Supervisors to place the developing Implementation Plan documents on the County website, inviting Open Comment by all stakeholders online over the next eight months.  Governmental planning has utilized this procedure regularly to broaden the opportunity for public input on important strategic plans and policy changes.   

  2. Partner with the Community Foundation of Sonoma County to achieve their Strategic Plan Goal #2.

I’m asking the Board to act on a recent invitation by the Community Foundation of Sonoma County when it revealed on July 10th. its new Strategic Plan, and expressed their desire to partner with us.

Motion: To advise the Department of Health Services and the Sonoma County Board of Supervisors to invite the Community Foundation of Sonoma County into a partnership in the development of our Integrated Plan.

Community Foundation Strategic Plan Goal # 2:

“We will partner with organizations that expand access to healthcare and mental health support, especially for communities historically excluded from care.  By centering community voice, we will support systems change that leads to more just, responsive health outcomes.”

Our Board’s responsibility under Proposition One is to develop this fall an Integrated Plan for all funding available, and I believe that partnering with the Community Foundation of Sonoma County would expand the resources and options available and would be an exciting message to our community.

Gregory

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 18th. 
  • MHSA Program Steering Committee, 1-3pm, 2227 Challenger Way, Galaxy Room (next to Room 201)
  • Measure O Oversight Committee, 4-5:30pm, 1450 Neotomas Ave, Suite 200. Quarterly meeting to review finances and progress on programs funded.

On January 28th, the Santa Rosa City Council considered, and then delayed approval of a an application to the State of California Department of Housing and Community Development’s HomeKey+ Grant Program for the City to be a co-applicant with Burbank Housing Development and Caritas Homes Phase II LLC in an amount not to exceed $13.95 million.  The grant is for the development of permanent supportive housing for individuals or households with an individual who is homeless, chronically homeless, or at risk of homelessness and who are also living with a behavioral health challenge. Caritas Homes Phase II, the final stage of the Caritas Village project located in downtown Santa Rosa will add 30 new affordable apartments reserved for homeless individuals referred through the Sonoma County Coordinated Entry system, meets the eligibility criteria for HomeKey+ funding.  The item was pulled from the City Council agenda, and will be rescheduled at a later date.