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.”
Main Talking Points, and logistics for the Homeless Coalition and Board of Supervisors meeting:
Most of this money could go to efforts that are not restricted by MediCal, and only help those with an Acute Mental Illness diagnosis and/or Substance Abuse disorder. $600 million dollars should serve more than 500 people.
This plan does not work to strengthen the “One System of Care.” It doesn’t match the Homeless Coalition strategic plan or the MRG report adopted by the Homeless Coalition both of which strive for that important goal.
This plan was made with abysmal Community Engagement. For example, neither Catholic Charities nor the Homeless Coalition were consulted.
Board of Supervisors Meeting Tuesday, June 2, 9 am In person 575 Administration Drive, Room 102A, Santa Rosa Public Comment period, only in person
Before June 30
Reach out to Michelle Bass, Director of California Department of Health Services, with the messages above about the Sonoma Counties Behavioral Health 3-Year Integrated Plan. Suggest that the state take action.
Michelle Baass (916) 440-7400
Department of Health Care ServicesP.O. Box 997413, MS 0000 Sacramento, CA 95899-7413
Ongoing Work
Influence leadership of county staff over time toward Accountability and Transparency:
Talk to the new people: head of the health department Nolan Sullivan, county CEO, David Guhin, Fiscal Director of Health Department Maryann Le , homeless division manager Hunter Scott.
Talk to Angela Stuckman head of the Human Services Dept.
Know that what is coming, (massive budget cuts, cuts to Food Stamps & MediCal), will overwhelm the county staff and make the changes related to this plan seem like small potatoes. Be kind but firm that challenges are best met with a community response. Including people is time consuming and sometimes annoying but the best solutions come from this basic democratic process.
California Continuums of Care and the California Interagency Council of Homelessness have funded homeless management information systems (HMIS) at the county and state level in an attempt to track and evaluaste the outcomes achieved by millions of dollsrs in homeless facility and program services over the past ten years. Nevertheless, long-term tracking of chronic homeless housing outcomes has been hindered by the lack of adequate intra-system and facility tracking. Which counties have successfully moved homeless from the streets to shelters and permanent housing, and retained them ?
The dilemma you are highlighting cuts to the absolute core of California’s multi-billion-dollar battle with homelessness. You hit the nail on the head: while the state has funneled billions into local Continuums of Care (CoCs) and launched the Homeless Data Integration System (HDIS) under Cal ICH to patch these exact data gaps, getting a precise, county-by-county report card on long-term retention is incredibly tricky.
Because of “intra-system tracking gaps”—such as people crossing county lines, or dropping out of the Homeless Management Information System (HMIS) with “unknown” exit destinations—success is rarely measured by sweeping regional victories. Instead, it is measured by specific counties that have built highly coordinated, localized data structures to bypass these limitations.
According to data from Cal ICH’s statewide assessments, university studies (like UCSF’s landmark California Statewide Study of People Experiencing Homelessness), and local CoC reports, a handful of counties stand out for their success in moving people from streets to shelters, securing permanent housing, and keeping them there.
1. Santa Clara County (Silicon Valley CoC)
Santa Clara County is widely regarded as an intra-system data leader because they actively track their “Community Plan to End Homelessness” milestones with sharp precision, accounting for where individuals end up.
The Transition: Between 2020 and 2023, the county successfully placed over 10,000 people into permanent housing. They consistently beat regional averages by transitioning roughly 37% of people straight out of temporary emergency shelters directly into permanent homes (the regional target is usually 30%).
The Retention: This is where they excel. Santa Clara County reports an astonishing 95.8% housing retention rate within its Permanent Supportive Housing (PSH) programs. Their system is highly tightly knit, meaning if someone is placed, intensive case management keeps them tracked and stable.
2. San Diego County (San Diego City & County CoC)
San Diego has made massive strides by aggressively deploying “diversion” strategies and leveraging HDIS data to track specific sub-populations, particularly veterans and chronically homeless individuals.
The Transition: San Diego scaled up its street outreach-to-shelter funnel by utilizing decentralized navigation centers. By integrating their regional HMIS more tightly across cities within the county, they successfully increased successful permanent housing placements out of rapid rehousing and street outreach.
The Retention: San Diego’s built-in retention frameworks keep their permanent supportive housing stability rate hovering around 85% to 90%. They have been specifically highlighted for lowering the rate of people who “return to the streets” within two years of being housed.
3. Riverside & Bakersfield/Kern County
If you look at the raw data of “functional zero”—a metric meaning a system can house more people a month than are entering homelessness—these two regions punch far above their weight.
The Transition: Bakersfield/Kern County famously became the first community in California to achieve “functional zero” for chronic homelessness. They did this by establishing a daily-updated, master “By-Name List” shared across every shelter and facility, fundamentally eliminating the intra-system tracking gap you mentioned.
The Retention: Because their system treats every chronically homeless individual as a specific case file shared by all providers, their retention rates for permanent housing placements are among the sturiest in the state, keeping returns to the street below 10%.
4. Los Angeles County (LAHSA / LA County CoC)
LA County is a paradox. Because of its sheer size, it has the highest raw number of returns to homelessness. However, when looking purely at facility tracking and retention efficacy, their targeted programs tell a different story.
The Transition: Through initiatives like Project Roomkey and subsequent permanent conversions (Project Homekey), LA moved tens of thousands of unsheltered individuals into temporary motels and then permanent supportive housing.
The Retention: LA’s data shows that when a chronically homeless individual is successfully placed into Permanent Supportive Housing (PSH) paired with intensive case management, the retention rate sits above 85%. The breakdown happens not because the facilities fail to retain them, but because the inflow of newly homeless people vastly outpaces the physical availability of those permanent units.
The Core Data Reality: Why the Tracking Breaks Down
Cal ICH’s sweeping Statewide Homelessness Assessment highlighted exactly what you noted: the “Unknown” problem.
Across California’s aggregated HDIS data, when looking at people who exit homelessness programs:
28% exit to housing without a subsidy (moving in with family/friends or renting).
17% exit to housing with a temporary or permanent subsidy. Business, Consumer Services and Housing Agency – CA.gov
17% are known to remain in sheltered or unsheltered homelessness. Business, Consumer Services and Housing Agency – CA.gov
25% are recorded as “Unknown.” Business, Consumer Services and Housing Agency – CA.gov
The Takeaway: When a county’s data shows a drop in chronic homelessness, it is often difficult to prove whether those individuals were permanently retained, moved to a different county, or simply stopped interacting with service providers entirely, causing them to fall off the HMIS grid. The counties winning this battle are the ones using localized, real-time “By-Name” data systems rather than relying purely on historical, retrofitted HMIS data uploads.
Want to look closer at how ‘By-Name Lists’ fix California’s tracking gaps?Yes
How do By-Name Lists work in HMIS, and how do they prevent chronically homeless individuals from falling through intra-system tracking gaps?
A standard Homeless Management Information System (HMIS) operates like a traditional database. It takes snapshots of data, tracks transactions (like a bed night or a meal), and aggregates that data for state or federal reporting.
The problem? It is backward-looking. A standard HMIS tells you how many people you served last quarter, but it rarely helps a case worker figure out where a specific chronically homeless person is this afternoon.
A By-Name List (BNL) shifts the paradigm from aggregate tracking to real-time coordination. It is a continuously updated, frontline roster of every single person experiencing homelessness in a given community.
How a By-Name List Works
Instead of waiting for a person to walk into a facility to generate a data point, a By-Name List pulls data dynamically from HMIS and street outreach teams into a centralized, living document.
[ Street Outreach ] ──┐
[ Emergency Shelter ] ─┼─> [ Centralized By-Name List ] ──> [ Case Conferencing Team ]
[ Medical/Jails ] ────┘ (Real-time status updates) (Matches person to next open bed)
The process generally follows four core mechanics:
Universal Identification: Every individual is added to the list by name, accompanied by their specific health vulnerabilities, history of homelessness, and current location or “frequent hangouts.”
Acuity Scoring: Communities use a standardized tool—most commonly the VI-SPDAT (Vulnerability Index – Service Prioritization Decision Assistance Tool)—to assign a score based on how likely that person is to die or suffer severe harm on the streets.
Dynamic Status Tracking: Individuals are tagged with a real-time status: Active (currently unsheltered/sheltered), Housed (successfully placed), or Inactive (has not been seen or heard from by any provider in 90 days).
Cross-Agency Case Conferencing: Every week or two, representatives from housing authorities, mental health agencies, street medicine teams, and shelters sit in a room with the list. They don’t talk about general statistics; they go line-by-line: “Where is John Doe? His name is next for the PSH apartment that opened up yesterday.”
How it Fixes Intra-System Tracking Gaps
By changing how data is gathered and viewed, a By-Name List directly plugs the data leaks that plague standard county HMIS frameworks:
1. Eliminating the “Unknown Exit” Black Hole
In a traditional system, if a person leaves a temporary shelter, their file is closed as “Exit Destination: Unknown,” and they effectively become a ghost until they re-register elsewhere.
The BNL Fix: Because street outreach teams use the same list, if an individual leaves a shelter and goes back to a riverbed or encampment, the outreach team updates their status back to “Active – Unsheltered” and logs their coordinates. The continuity of their profile remains unbroken.
2. Prioritizing by Need, Not “First-Come, First-Served”
Standard HMIS queues often reward the people who are functional enough to show up to an office early in the morning. The most severely chronically homeless individuals—often suffering from severe mental illness or cognitive decline—rarely fill out the paperwork.
The BNL Fix: The list is ordered by vulnerability, not chronology. The system actively hunts for the person at the top of the list, using the collective memory of all county providers to find them when a permanent housing voucher becomes available.
3. Preventing Multi-Agency Duplication
Without a centralized list, a person might get a mental health evaluation from County Agency A, a shelter bed from Non-Profit B, and street medicine from Group C. In standard HMIS, these can look like three different people or disconnected parallel tracks.
The BNL Fix: It forces an intra-system “single source of truth.” All three entities update the same file, ensuring that the housing navigator knows exactly what medical clearings or documents the person already has, slashing administrative delays.
4. Defining “Functional Zero”
Without a By-Name List, a county cannot accurately measure if it is winning the battle. They are just guessing based on point-in-time counts conducted once a year.
The BNL Fix: Because the list tracks exact inflow (people falling into homelessness) and outflow (people getting housed or moving away) in real time, a county knows exactly when its housing capacity matches its demand.
The Reality Check: A By-Name List is only as good as the human infrastructure supporting it. It requires strict data-sharing agreements between competitive non-profits and county agencies, alongside relentless field outreach. When done right—as seen in communities like Bakersfield—it turns a fractured web of independent shelters into a single, cohesive triage system.
Street outreach is one of the most critical, challenging, and misunderstood components of the modern homelessness response system. When people think of outreach, they often picture workers handing out blankets or water bottles. While emergency survival aid is part of the job, the true “success” of modern street outreach lies in its evolution into a professional, housing-focused pipeline.
National Alliance to End Homelessness
Rather than just managing the crisis of unsheltered conditions, successful outreach teams act as mobile case managers who meet people where they are to actively end their homelessness.
1. Shifting from “Band-Aids” to Housing
Historically, street outreach was focused purely on harm reduction and basic survival. Today, successful programs are strictly housing-focused. Outreach workers build trust over weeks or months to accomplish the practical milestones required to get someone off the street:
Document Readiness: One of the biggest barriers to housing is a lack of identification. Successful outreach teams turn “impossibilities into successes” by helping individuals replace lost birth certificates, social security cards, and state IDs, and navigating complex government bureaucracy. HomeFirst
Coordinated Entry Integration: Teams use localized data systems (like the Homeless Management Information System, or HMIS) to assess individuals directly in the field. This ensures that the most vulnerable people sleeping outside are prioritized and seamlessly matched with open shelter beds, rapid rehousing programs, or permanent supportive housing.
2. Real-World Success Models
Across the country, targeted outreach models combined with rapid funding are showing measurable success:
The “Pathway Home” Initiative (Los Angeles County): This encampment resolution program specifically pairs street outreach with immediately available interim housing. Instead of just asking people to move along, outreach teams bring entire encampments indoors together, offering a comprehensive suite of medical care, mental health support, and dedicated case managers. LA County Homeless Initiative
Family Reunification Programs: Often, the fastest route out of homelessness is reconnecting individuals with support systems they already have. Outreach workers frequently find success through structured “return home” initiatives—gaining an individual’s trust, locating family members in other cities or states, and coordinating safe travel and warm handoffs. Downtown Development District
Multidisciplinary Teams: Some of the most successful urban outreach programs now utilize hybrid teams that include peer navigators (individuals with lived experience of homelessness), mental health professionals, and substance use counselors. This allows teams to provide trauma-informed care and immediate medical or psychiatric support directly on the sidewalk.
3. The Power of “Warm Handoffs”
In professional street outreach, success is rarely defined by handing someone a flyer with a list of resources. Because navigating a fragmented system is incredibly overwhelming—especially for those dealing with chronic health issues or severe trauma—success relies on warm handoffs.
An outreach worker doesn’t just tell someone where a clinic or shelter is; they walk with them, drive them to appointments, introduce them to the shelter staff, and stay with them through the intake process. This continuity of care is what prevents vulnerable people from slipping through the cracks.
The Underlying Challenge: Street outreach workers are highly effective at building trust and preparing people for housing, but their ultimate success is entirely dependent on the availability of low-barrier shelters and affordable housing. Outreach can bridge the gap, but it requires a robust housing continuum to permanently resolve the crisis.
National League of Cities
Would you like to look at specific local outreach programs or data for a particular region?Yes
What are the specific street outreach programs and success statistics for the Bay Area and Northern California?
In the Bay Area and Northern California, street outreach has evolved from basic survival aid into a data-driven, coordinated effort to transition unsheltered people directly into housing and shelter. Local municipalities and regional Continuums of Care (CoCs) track these metrics closely, and recent reports reveal clear evidence of progress, alongside ongoing challenges.
1. Santa Rosa and Sonoma County (Northern California)
Sonoma County and its largest city, Santa Rosa, have demonstrated measurable success by combining street outreach with expanded affordable and interim housing infrastructure.
Local News Matters
Steep Overall Declines: The Point-in-Time (PIT) Count revealed that the total number of individuals experiencing homelessness countywide dropped by 23%, falling to 1,952 individuals—the lowest total recorded since the count began in 2007 (Sonoma County Department of Health Services, 2025). In Santa Rosa specifically, homelessness dropped by 16% (City of Santa Rosa, 2025). Nearby Rohnert Park saw an even more dramatic 60% reduction in overall homelessness, including a 78% drop in unsheltered individuals, which local officials directly attributed to targeted outreach and the 2022 opening of Labath Landing, an interim housing site (Local News Matters, 2025). SRCity.org+ 2
Street Outreach Transition Rates: In the city of Santa Rosa, street outreach teams have become highly effective at creating a direct pipeline off the streets. During the 2024–2025 fiscal year, city-funded programs engaged thousands of individuals, successfully helping nearly 30% of all unsheltered people met through street outreach transition into formal shelters or permanent housing (City of Santa Rosa, 2025). SRCity.org
Targeted Subpopulation Success: Regional outreach coupled with dedicated housing vouchers led to a 39% reduction in homeless veterans countywide (Sonoma County Department of Health Services, 2025).
The Chronically Homeless Challenge: Despite these outreach successes, the data highlights a major systemic bottleneck: the number of individuals experiencing chronic homelessness (those on the street for over a year with a disabling condition) rose by 20% (Sonoma County Department of Health Services, 2025). This underscores the fact that while outreach workers are successfully engaging people, the most vulnerable require longer-term permanent supportive housing (PSH) slots, which remain in short supply.
2. San Francisco and the “Home by the Bay” Strategy
San Francisco relies heavily on multidisciplinary street teams—including the Street Crisis Response Team (SCRT) and SF Homeless Outreach Team (HOT)—to handle non-violent, health-focused crises and provide direct shelter placement.
Substantial Housing Placements: San Francisco’s overarching strategic initiative reported that between July 2023 and June 2025, the homelessness response system successfully supported 10,300 people in moving from homelessness into permanent housing (SF.gov, 2025). SF.gov
High Housing Retention Rates: One of the most significant statistical successes of the Bay Area system is what happens after outreach connects someone to a home. In San Francisco, 93% of individuals who exited homelessness did not return to the homelessness system within 12 months, comfortably exceeding the city’s 85% target (SF.gov, 2025). SF.gov
On-Demand Placements via the RESTORE Project: San Francisco expanded its RESTORE project, an outreach initiative designed to provide immediate substance use treatment and nighttime shelter placements directly from the street, serving more than 2,500 clients (SF.gov, 2025). Additionally, street outreach and neighborhood-based ambassador programs contributed to a 30% to 60% reduction in 911 calls in the specific neighborhoods where they were deployed, proving that proactive street engagement relieves pressure on emergency services (SF.gov, 2025). SF.gov
3. Berkeley and the East Bay
In the East Bay, specialized outreach models have been tested to bridge the gap between psychiatric crisis and housing.
The HOTT Model: The City of Berkeley’s Homeless Outreach Treatment Team (HOTT) is a prominent example of a specialized outreach pilot (City of Berkeley, 2023). Funded largely by the Mental Health Services Act, HOTT utilizes an evidence-based framework known as Critical Time Intervention (CTI) (City of Berkeley, 2023).
Vibe of the Program: Rather than focusing on short-term fixes, the team focuses entirely on building long-term, trusting relationships with highly vulnerable unhoused individuals who have severe mental health needs, physically navigating them through the fragmented county system to achieve long-term housing stability (City of Berkeley, 2023).
Summary of Regional Success Data
The overall picture of street outreach in Northern California shows that the mechanics of outreach are working. When teams are deployed with adequate resources, they are achieving high transition rates (such as Santa Rosa’s 30% pipeline success) and exceptional housing retention rates (such as San Francisco’s 93% stability rate). The primary constraint on these programs’ success remains macro-economic: a severe regional shortage of affordable housing units and state/federal budget cuts that restrict the number of permanent beds outreach teams can offer to the people they engage on the street.
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
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.
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.
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.
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.
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.
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.
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.
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.
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
Fill 100% of rooms for homeless people in County-owned facilities through the Coordinated Entry System.
Begin a formal SmartCare-to-HMIS Coordination immediately with a 3-month timeline for completion.
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.
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.
Insist upon a robust and meaningful community discussion before further implementation.
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.
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/Adjustment
Details
Federal Medicaid Cuts
Anticipated reductions threaten core behavioral health and homelessness services1
Measure O Reliance
Funds 58.33 staff; projected ending balance of $7.1M is a major concern2
Realignment Fund Depletion
Local funds are dwindling, increasing fiscal pressure3
NOFA ($10M)
New funding opportunity to support at-risk programs; deadline: Sept 174
Strategic Reorganization
Homelessness team moving under behavioral health to leverage Medi-Cal billing5
Allocation Adjustments
Possible 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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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:
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.
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.
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:
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.
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.
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.
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.
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.
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.
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 devastateMedi-Cal and community clinics, disproportionately impacting Latino families. A panel of local health leadersreinforced the urgency, discussing the local impact of these cuts, the rise in uninsured patients, and the strain onservices. 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 thanforming 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) wasrecognized.A tribute was paid to Rick Nolan, the retired CEO of the Luther Burbank Center, for his decade-long partnershipand 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 challengesfacing healthcare.
Impact on Latino Communities:
Cuts to Medi-Cal and community health centers are direct cuts to the Latino community, as they form thelargest 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 andintroducing 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 communityhealth 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 healthcaresafety 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 whilesimultaneously 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 reportinga 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 toimmigration 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 localhealth 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 andhousing 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 andpractice where they train.
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.
Homeless Emergency Assistance Program Association 