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Health and Human Services Agency (HHSA) recommending the Board:
1) Adopt El Dorado County’s Behavioral Health Services Act (BHSA) Fiscal Year (FY) 2026/27 through 2028/29 Integrated Plan (IP) (Attachment A);
2) Authorize the implementation of the FY 2026/27 through 2028/29 projects included within the IP;
3) Authorize the HHSA Director, or Chief Assistant Director, to approve revisions to the adopted BHSA IP when directed by the California Department of Health Care Services; and
4) Approve and authorize the Chair to sign and complete the Board of Supervisors Certification (Attachment B), signifying the Board’s review and approval of the BHSA IP and certifying to County compliance with ensuring timely access to Medi-Cal managed care services for beneficiaries, pursuant to Welfare and Institutions Code Section 14197.
FUNDING: 32% Medi-Cal Federal Financial Participation, 25% BHSA funding, 16% Realignment, 14% Opioid Settlement Funds, 4% State General Fund, 2% Federal grants, 7% other various sources.
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DISCUSSION / BACKGROUND:
In 2004, California voters passed Proposition 63, the Mental Health Service Act (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 have been 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.
In March 2024, California voters approved Proposition 1, enacting Senate Bill (SB) 326 known as the BHSA, replacing MHSA and modernizing county behavioral health planning, funding allocations, and outcome reporting. The BHSA restructures how the State of California allocates behavioral health funding and operationalizes planning requirements with an increased statewide emphasis on individuals with the most significant behavioral health needs, including individuals experiencing serious mental illness, substance use disorders, and homelessness. The BHSA requires counties to submit three-year IPs to DHCS that outline how it will utilize all available behavioral health funding sources, including BHSA funds, to meet local needs and reduce disparities in behavioral health services. The BHSA IP will also facilitate local and statewide data collection by providing baseline data on services and planned expenditures and supporting analysis of county goals and outcomes. Counties must submit three-year BHSA IPs covering FY 2026/27 through 2028/29, aligning spending to statewide goals, and compliance with new accountability measures. It is important to note that the BHSA IP is replacing the County’s previous MHSA Three-Year Expenditure Plan, which focused solely on MHSA-funded programs.
Process changes under the BHSA include:
a. Expanded stakeholder engagement requirements under WIC 5963.03; and
b. County Draft IPs are due March 31 annually to DHCS for review and required revisions.
Financial changes under the BHSA include:
a. Counties must detail use of all behavioral health funding sources including but not limited to BHSA, Realignment, Medi-Cal- Federal Financial Participation (FFP), federal and non-federal grants, OSF and local funds;
b. Counties must maximize FFP revenue opportunities;
c. Counties are expressly prohibited from using BHSA funding to duplicate services available through other Behavioral Health Delivery Systems (BHDS) including but not limited to Medi-Cal Managed Care Plans (MCP), private insurance, and the Children and Youth Behavioral Health Initiative (CYBHI); and
d. Required component specific allocation of BHSA dollars:
- Full-Service Partnership (FSP) 35%;
- Housing Interventions (HI) 30%: At least 50% of HI must be allocated to chronically homeless individuals and no more than 25% of HI allocated to Capital Projects, and no more than 7% of HI is to be allocated to Housing Outreach and Engagement (O&E).
- Behavioral Health Services and Supports (BHSS) 35%: At least 51% of BHSS must be allocated to Early Intervention (EI) and at least 51% of EI must be allocated to services to individuals under the age of 25.
Service changes under the BHSA include:
a. Required: High Fidelity Wraparound service modality for eligible youth receiving Specialty Mental Health Services (SMHS);
b. Required: Inclusion of Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT), entitlement benefits including Functional Family Therapy (FFT), Multisystemic Therapy (MST), and Parent Child Interaction Therapy (PCIT);
c. Required: Coordinated Specialty Care First Episode Psychosis (CSC FEP); and
d. Elimination of population-based prevention programs.
Monitoring and Reporting changes under the BHSA include:
a. Expand provider monitoring to align with Medi-Cal- standards for all BHSA funded programs including but not limited to checking insurance status and regular interval site visits;
b. Individual Service Level (ISL) detailed reporting requirements represents a significant operational shift for counties, requiring expanded person-level service tracking, fiscal reporting, provider oversight, and alignment of BHSA-funded services with evolving state documentation and accountability standards (final guidance has yet to be released but initial ISL reporting is due January 2027);
c. Behavioral Health Outcomes, Accountability, and Transparency Report (BHOATR) (this report template has not yet been released); and
d. County’s BHOATR Draft for FY 2026/27 through 2028/29 is due January 30, 2028, to DHCS for review and revision; County’s Final IP is due January 30, 2029.
HHSA is recommending the Board adopt El Dorado County’s BHSA IP for FY 2026/27 through 2028/29, which will become effective July 1, 2026, and implementation of the FY 2026/27 projects within the IP. HHSA does not recommend disclosure of any challenges or concerns.
ALTERNATIVES:
Should the Board disapprove of the BHSA IP for FY 2026/27 through 2028/29, this may result in not only HHSA’s inability to provide continuity of care for clients currently receiving behavioral health services from contracted vendors but may also result in the County being out of compliance with the requirements of the BHSA. Services are mandated by the County's executed Mental Health Plan (MHP) and Drug Medi-Cal Organized Delivery System (DMC-ODS) agreements with DHCS. These agreements with DHCS must continue but the County will not have the option to use BHSA revenue for the required non-federal match.
PRIOR BOARD ACTION:
01/27/26, 25-2044, HHSA Resolution 017-2026, exempts Procurement Policy C-17 competitive bidding requirements for specified BHSA services during Fiscal Years 2026-2029
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
HHSA Social Services, HHSA Community Services, El Dorado County Office of Education, County Library Services, El Dorado County Probation Department and El Dorado County Sheriff’s Office.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no new Net County Cost associated with the BHSA IP. Sufficient appropriations have been included in the Fiscal Year 2026/27 budget request and will be included in future year budgets as appropriate.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
Clerk of the Board to obtain signature of Chair on one original Board of Supervisors Certification.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency