Behavioral health modernization plan puts emphasis on accountability

By Tara Gamboa-Eastman
Director of Government Affairs

Tara Gamboa-Eastman

Tara Gamboa-Eastman
Director of Government Affairs

This year the Steinberg Institute was thrilled to support Governor Gavin Newsom’s Behavioral Health Modernization Proposal, which sought to reform the Mental Health Services Act (MHSA). The MHSA, authored by Institute founder and Sacramento Mayor Darrell Steinberg, placed a 1% tax on personal income over $1 million to fund mental health services in California.

The MHSA was borne out of two pieces of legislation – AB 34 (Steinberg, 1999) and AB 2034 (Steinberg and Baugh, 2000) – authored by then-Assemblymember Steinberg that established a “whatever it takes” approach to care for people living with a serious mental illness and experiencing homelessness. These bills showed dramatic reductions in homelessness, incarceration, and hospitalization. In 2004, voters overwhelmingly approved the MHSA with this model at its core.

Nearly 20 years later, without proper state oversight and guidance, spending has strayed from the MHSA’s original intent of focusing on serious mental illness and homelessness.

The Governor’s modernization proposal represents a tremendous opportunity to get back to this original vision for the MHSA. One key component of the proposal that will help us achieve our goals of serving the most vulnerable Californians is the proposal’s focus on strict accountability.

Chiefly, the proposal creates a new County Integrated Plan for Behavioral Health Services and Outcomes, which includes all local behavioral health funding and services, including Medi-Cal. These plans will require:

  • Counties to demonstrate coordinated behavioral health planning using all services and sources of behavioral health funding;
  • Stratified local data analysis to identify behavioral health disparities in geography and demography, including age, gender, ethnicity, and race, and include approaches to eliminate those disparities; and
  • The Department of Health Care Services to work with counties and stakeholders to establish outcome metrics for state and county behavioral health services and programs.

Additionally, the proposal establishes a new, annual County Behavioral Health Outcomes, Accountability, and Transparency Report to provide public visibility into county results, disparities, spending, and longitudinal impact on homelessness.

This new emphasis on strict accountability will ensure that our behavioral health systems are always improving to best meet the needs of Californians in need of care. The Behavioral Health Modernization Proposal will be on the March 2024 ballot for voter approval as Proposition 1.

Key points from Governor Newsom’s Fact Sheet:

OUTCOMES: The proposal replaces the existing MHSA funding-specific plan with a new County Integrated Plan for Behavioral Health Services and Outcomes, which includes all local behavioral health funding and services, including Medi-Cal.

  • Requires counties to demonstrate coordinated behavioral health planning using all services and sources of behavioral health funding (e.g., BHSA, opioid settlement funds, realignment funding, federal financial participation), to provide increased transparency, stakeholder engagement, and outcomes for all local services.
  • Requires stratified local data analysis to identify behavioral health disparities in geography and demography, including age, gender, ethnicity, and race, and include approaches to eliminate those disparities.
  • Requires the Department of Health Care Services (DHCS) to work with counties and stakeholders to establish outcome metrics for state and county behavioral health services and programs.

ACCOUNTABILITY: The proposal establishes a new, annual County Behavioral Health Outcomes, Accountability, and Transparency Report to provide public visibility into county results, disparities, spending, and longitudinal impact on homelessness.

  • Requires counties to report to DHCS their annual services, outcomes, and expenditures of state and federal behavioral health funds, unspent dollars, and other information. Authorizes DHCS to impose corrective action plans on counties that fail to meet the requirements established by this section.
  • Authorizes an additional 2% (and up to 4% for counties with a population of 200,000 or less) of local BHSA revenue to counties to improve their planning, quality, outcomes, data reporting, and subcontractor oversight for all county behavioral health funding, on top of the existing 5% county administrative cost share.
  • Reduces authorized local prudent reserve amounts in the BHSA to allow for needed investments while still saving for an economic downturn, while clarifying flexibility to fund reserves and establishing a new work group on BHSA funding volatility and prudent reserves.
  • Strengthens the independent Mental Health Services Oversight and Accountability Commission (MHSOAC) by increasing its scope of advisory review to all behavioral health funding, mirroring the county integrated plans and reports; continuing its status as an independent agency; adding additional community representation, namely for transition-age youth and for individuals who are aging or disabled, and other critical community perspectives; and funding a new $20 million Innovation Partnership Fund to provide grants to develop innovations with non-government partners.
  • Directs the State Auditor to report on the progress and effectiveness of the state Behavioral Health Services Act.
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