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Health and Human Services Agency (HHSA) recommending the Board:
1) Receive a presentation on El Dorado County’s Mental Health Services Act (MHSA) Fiscal Year (FY) 2024-25 Annual Update; and
2) Discuss the draft MHSA Annual Update FY 2024-25 and provide direction, if needed, in advance of a future Board request to adopt a finalized MHSA FY 2024-25 Annual Update.
FUNDING: 72% MHSA funds, 21% Federal Medi-Cal, 2% Federal Block Grants, 1% Realignment/State General Fund, and 4% 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 (or the “MHSA Plan”), and perform 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.
On June 20, 2023, the County’s most recent MHSA Plan, covering FY 2023-24 through FY 2025-26, was adopted by the Board (File ID: 23-0591), with an amendment to said Plan adopted by the Board on February 27, 2024 (File ID: 24-0084). HHSA is presenting on the proposed FY 2024-25 Annual Update to this MHSA Plan in this agenda item.
Prior to this Board presentation, HHSA Behavioral Health Division (BHD) publicly posted the draft FY 2024-25 MHSA Plan Update on the County’s MHSA web page for a 30-day review and public comment period on January 12, 2024. Additionally, on February 21, 2024, following the 30-day period, the Behavioral Health Commission (Commission) conducted a public hearing to receive any additional input from the community. The Commission serves as an advisory to the County Board and County Mental Health Director by reviewing and evaluating community mental health needs, services, facilities, and special problems in adherence with California Welfare and Institutions Code (WIC) §5604. Any substantive comments that were received about the draft Update during the 30-day comment period or the Commission’s Public Hearing process will be 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). These MHSA Plan components and added, modified, or removed County MHSA Projects are summarized below:
Component 1: CSS, focuses on the development of recovery-oriented services for children, youth, adults, and older adults with serious mental illness.
New CSS Projects:
1. Full Service Partnership (FSP) Unhoused Individuals Project, more effectively meets the needs of unhoused individuals struggling with Serious Mental Illness through expanded and specialized Full Service Partnership programming that will be incorporated into El Dorado County’s integrated HHSA Housing and Homelessness Service structures.
Modified CSS Projects:
1. Crisis Residential Treatment (CRT) Project, expands the services description and addition of a CRT sub-program to provide step-down services to clients prior to entering the CRT. This modification was approved in the FY 23/24 Plan Amendment (File ID: 24-0084).
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 in 2018 Senate Bill 1004.
New PEI Projects:
1. Project Access Community Outreach Initiative addresses the limitations of office-based intake systems and documented challenges of engaging clients experiencing greater barriers to access to services. Project Access will create dedicated community health engagement positions to link individuals with identified behavioral health and supportive service needs to the integrated service models provided by HHSA. This new project was approved in the FY 23/24 Plan Amendment (File ID: 24-0084).
Modified PEI Projects:
1. Community-Based Outreach and Linkage Project has been modified to address mandated California Department of Health Care Services (DHCS) requirements set forth in Behavioral Health Information Notice (BHIN) 23-025 requiring all counties to implement 24/7 Medi-Cal Community-Based Mobile Crisis Intervention Services. This modification was approved in the FY 23/24 Plan Amendment (File ID: 24-0084).
2. Community Stigma Reduction Project was modified to better serve a wider array of vulnerable community members. This modification was approved in the FY 23/24 Plan Amendment (File ID: 24-0084).
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 of Supervisor 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 Projects:
1. Partnership Between Senior Nutrition and Behavioral Health to Reach Home-bound Older Adults in Need of Mental Health Services Project was not able to be implemented prior to MHSOAC approved deadline.
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 projects:
1. Workforce Development Project has been modified to support integrated Behavioral Health training initiatives, inclusive of Substance Use Disorder staff.
2. Integrated Community-based Wellness Center Project has been modified to accommodate renovation needs through increased funding after identifying a practical and suitable location for operation.
HHSA BHD plans to incorporate feedback garnered from this agenda item in a finalized MHSA Plan FY 2024-25 Annual Update and plans to bring said Plan Update before the Board by June 18, 2024, to request formal Board adoption of the MHSA Annual FY 2024-25 Update, which is intended to become effective July 1, 2024.
ALTERNATIVES:
Should the Board disapprove of the proposed MHSA Annual Update for FY 2024-25, 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 El Dorado County being out of compliance with the requirements of the MHSA. Consequently, 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.
PRIOR BOARD ACTION:
1) 06/20/17, 17-0551, HHSA MHSA FY 2017-18 - FY 2019-20 Three-Year Program and Expenditure Plan
2) 06/26/18, 18-0874, HHSA MHSA FY 2018-19 Annual Update
3) 06/25/19, 19-0936, HHSA MHSA Plan Update FY 2019-20
4) 06/09/20, 20-0446, HHSA MHSA FY 2020-21 - FY 2022-23 Plan Approval
5) 06/22/21, 21-0713, HHSA MHSA Plan Update 2021-22
6) 07/19/22, 22-1046, Approval of 2022-2023 Suicide Prevention Strategic Plan
7) 08/30/22, 22-0832, HHSA 2022-2023 MHSA Plan Update
8) 05/09/23, 23-0591, Review of HHSA MHSA FY 2023-24 - FY 2025-26 Plan
9) 06/20/23, 23-0933, HHSA MHSA FY 2023-24 - FY 2025-26 Plan Approval
10) 02/27/24, 24-0084, MHSA Plan Amendment
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
HHSA Social Services, County Library Services, Probation Department, and Sheriff’s Office and the El Dorado County Office of Education all collaborated with HHSA BHD on the MHSA Plan and Annual Updates.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with the MHSA program and this agenda item. MHSA revenue and expenditures were included in the FY 2024-25 Recommended Budget request 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:
Safe and Healthy Communities
CONTACT
Olivia Byron-Cooper, MPH, Director