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Health and Human Services Agency (HHSA) recommending the Board:
1) Receive a presentation to review El Dorado County’s Mental Health Services Act (MHSA) Fiscal Year (FY) 2025-26 Annual Update; and
2) Discuss the MHSA Annual Update FY 2025-26 revisions required by the Board, prior to the June 17, 2025, request for adoption of the MHSA Annual Update, which is intended to become effective July 1, 2025.
FUNDING: 52% MHSA funds, 36% Federal/State Medi-Cal, 6% Realignment, 4% State Behavioral Health Bridge Housing Grant, 1% Federal Block Grants, 1% Miscellaneous/Fee-for-Service.
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DISCUSSION / BACKGROUND:
In 2004, California voters passed Proposition 63, the MHSA. MHSA imposes a one percent tax on personal income in excess of $1,000,000. The funds from the tax are distributed to California counties and are intended to transform the Mental Health System into one that is consumer and family driven, recovery-oriented, accessible, culturally competent, and a system that offers services appropriate for the population that is served.
MHSA requires counties to prepare a three-year program and expenditure plan, known as the MHSA Three-Year Program and Expenditure Plan with subsequent Annual Updates to the Plan. The MHSA Plans and Annual Updates are to be developed with input from local stakeholders, including adults and older adults with severe mental illness; families of children, adults and older adults with mental illness; providers of services; law enforcement agencies; educational agencies; social services agencies; veterans and representatives from veteran organizations; providers of substance use disorder services; and health care organizations. This public planning process is utilized to provide an opportunity for stakeholders and interested parties to discuss mental health policy, program planning, implementation, monitoring, quality improvement, evaluation, and budget allocations.
The draft FY 2025-26 Update was publicly posted for a 30-day review and public comment period on February 3, 2025. On March 19, 2025, following the 30-day period, the Behavioral Health Commission conducted a public hearing to receive any additional input from the community. Any substantive comments that were received about the draft Update during the 30-day comment period or the public hearing process were summarized and included in the final Update.
The MHSA Plans and Annual Updates are comprised of five components that address specific goals for priority populations and key community mental health needs. The components are Community Services and Supports (CSS), Prevention and Early Intervention (PEI), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities and Technology Needs (CFTN).
Component 1: CSS focuses on the development of recovery-oriented services for children, youth, adults, and older adults with serious mental illness.
New CSS Project:
1. Mobile Crisis Project (formerly Community-based Outreach and Linkage Project) has been moved from the PEI component to CSS Outreach and Engagement as a reflection of the more comprehensive services provided to current Behavioral Health Clients, Medi-Cal members, and the community. This project is being increased in order to meet State mandated requirements. An estimated 40% of project funding may be offset by Medi-Cal claiming for eligible mobile crisis contacts.
Modified CSS Projects:
1. These CSS projects budgets were reduced due to anticipated reduction in revenues and/or to align with historical annual expenditures:
a. Peer Partner Project - Parent Partner allocation has been reduced by $43,500.
b. Court Appointed Special Advocates (CASA) allocation has been reduced by $3,450.
c. Transitional Age Youth (TAY) Full Service Partnership (FSP) Project allocation has been reduced by $75,000.
d. Adult and Older Adult FSP Project allocation has been reduced by $1,000,000.
e. Wellness and Recovery Services/Adult Wellness Centers allocation has been reduced by $313,000.
f. Access Services allocation has been reduced by $225,000.
g. Assisted Outpatient Treatment (AOT) allocation has been reduced by $14,000.
h. Lanterman-Petris-Short (LPS) Project allocation has been reduced by $250,000.
i. Genetic Testing Project allocation has been reduced by $25,000.
2. The Community Wellness Center/Integrated Service Center Program within the larger Wellness and Recovery Services/Adult Wellness Center Project is being removed due to the alternative CFTN project to promote service integration.
3. Wellness and Recovery Services/TAY Engagement allocation has been increased by $200,000 to more accurately reflect offsetting Mental Health Block Grant (MHBG) Prime expenditures reported under this project.
4. Crisis Residential Treatment (CRT) Project allocation has been increased by $600,000 to meet needs identified through contracting process.
Removed CSS Projects:
1. Recreation Therapy Project is being removed due to the focus on mandated services. Recreational opportunities may still be accessible to FSP clients.
Component 2: PEI projects are designed to prevent a mental illness from becoming severe and disabling, to the extent possible. The included PEI projects meet the PEI regulations as amended in 2018 and Senate Bill 1004 (2018).
Modified PEI Projects:
1. The below PEI projects have been assessed for funding reductions and budgets reduced due to anticipated reduction in revenues.
a. Latino Outreach is being reduced by $60,000.
b. Primary Project is being reduced by $90,500 across its three independent providers.
c. Wennem Wadati: A Native Path to Healing Project is being reduced by $17,250.
d. Clubhouse El Dorado Project is being reduced by $45,000.
e. Older Adult Enrichment project is being reduced by $60,000.
f. Children 0-5 and Their Families Project is being reduced by $58,500.
g. Prevention Wraparound Services: Juvenile Services Project is being reduced by $75,000, and Engagement Project is being reduced by $50,000.
h. Student Wellness Center Project is being reduced by $267,120.
i. Mental Health First Aid, safeTALK and Other Community Education Projects is being reduced by $85,000 after re-evaluating the implementation strategy through the Community Funding Assistance opportunity and assessment of a lesser amount of funding required to accomplish the same or similar outcomes.
j. Community Stigma Reduction Project is being reduced by $15,000.
k. Community Education Project is being reduced by $150,000.
l. Peer Partner Project - Youth Advocate is being reduced by $16,500.
m. Mentoring for Youth Project is being reduced by $14,400.
n. Project Access is being reduced by $200,000.
o. Veterans Outreach Project is being reduced by $25,875.
p. Suicide Prevention and Stigma Reduction Project is being reduced by $200,000 with limited activities funded by MHSA following the June 2025 expiration of the Youth Suicide Reporting and Crisis Response Pilot Program Grant Funding. In accordance with Behavioral Health Services Act (BHSA) regulations, Suicide Prevention will be a function of Public Health with a percentage of MHSA revenue being distributed to the California Department of Public Health prior to distributions to counties.
Removed PEI Projects:
1. Goods and Services to Promote Positive Mental Health and Reduce Mental Health Risk Factors Project is being removed due to underutilization.
2. Bridge the Gap Project is being removed due to duplication with Managed Care Plan/private insurance responsibility.
3. National Suicide Prevention Line Project is being removed because as of the implementation of the 988 Lifeline, this service is no longer funded at the county level.
4. TimelyCare Project is being removed because it has been assessed as duplicating services that may otherwise be supported by alternative funding sources such as managed care plans and/or private insurance.
5. Statewide PEI Project is an optional project is being removed due to anticipated revenue reductions and emphasis on direct services.
6. Community-Based Outreach and Linkage Project/Psychiatric Emergency Response Team (PERT) (now Mobile Crisis Project) has been moved to CSS Outreach and Engagement.
Component 3: INN consists of projects that are designed to contribute to learning, rather than a primary focus on providing a service. In addition to the Board adoption of MHSA Plans and Annual Updates that include INN projects, the Mental Health Services Oversight and Accountability Commission (MHSOAC) also must approve INN projects. INN projects cannot exceed five years in duration.
Removed INN Project:
1. In-Clinic Certified Therapeutic Recreation Specialist Project is being removed due to the focus on mandated services.
2. Nature Therapy for Youth Project is being removed due to the focus on mandated services.
Components 4 and 5: WET and CFTN serve to support the development of a well-trained, qualified, and diverse workforce and strengthen the foundation of the mental health system. Since these components are no longer funded by the MHSA, counties transfer funds from the CSS component to fund these projects.
Modified WET Project:
1. The Peer Support Specialist Certification Program was added to the Workforce Development Project in order to utilize MHSA funding to grow the Peer Certified workforce within our staff and community. Client supported certification remains under the CSS Wellness and Recovery Project.
Removed WET Project:
1. Statewide WET Planning and Community Needs Assessment has been removed due to no state participation requirement.
Modified CFTN Projects:
1. Electronic Health Record Project is being expanded to include offline access software to be utilized by staff or providers while providing services in remote parts of El Dorado County, including but not limited to during Mobile Crisis responses. The project allocation has been increased by $100,000 to accommodate additional costs for services.
2. Service, Outreach, Access, and Response (SOAR) Project has been added for the option to utilize up to $1 million as a County match for potential Behavioral Health Continuum Infrastructure Program (BHCIP) grant funding.
Removed CFTN Projects:
1. Integrated Community-based Wellness Center Project has been removed due to re-evaluation of integrated services delivery with consideration of State BHCIP grant funding.
2. CFTN Administration: Housing Consultant - This program has been removed and the CFTN Administration allocation reduced by $100,000.
ALTERNATIVES:
Should the Board disapprove of the proposed MHSA Annual Update for FY 2025-26, including the denial of modified, new and/or discontinued projects, this may result in not only HHSA’s inability to provide continuity of care for clients currently receiving MHSA-funded services from contracted vendors but may also result in the County being out of compliance with the requirements of the MHSA. Consequently, the FY 2024-25 MHSA Annual Update to the FY 2023-24 - 2025-26 MHSA Three-Year Program and Expenditure Plan would continue as the foundation for MHSA services in the County, without the recommended updates that were framed by community members and stakeholders through the required public planning process and those prompted by anticipated revenue reduction.
PRIOR BOARD ACTION:
1) 05/09/23, 23-0591, HHSA MHSA FY 2023-24 - FY 2025-26 Plan Presentation and Update
2) 06/20/23, 23-0933, HHSA Adoption of FY 2023-24 - FY 2025-26 MHSA 3-Year Program and Expenditure Plan
3) 02/27/24, 24-0084, HHSA MHSA Plan Amendment
4) 04/23/24, 24-0466, HHSA 24/25 MHSA Plan Annual Update Draft
5) 06/18/24, 24-0832 HHSA MHSA FY 2024-25 Annual Update
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
HHSA Social Services, El Dorado County Office of Education, Library Services, El Dorado County Probation Department and Sheriff’s Office
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with the MHSA program. MHSA revenue and expenditures were included in the FY 2025-26 Recommended Budget and will be included in future year budget requests. Additional revenue sources that offset the MHSA expenditures have also been budgeted.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency