Myth: The BHSA only serves people covered by Medi-Cal.
Reality: The BHSA encompasses more than just services for Medi-Cal members; it supports a broader behavioral health continuum for all Californians.
While Medi-Cal plays an important role, the BHSA is designed to serve a broader population, including those who are uninsured or not eligible for Medi-Cal. Its goal is to reach those living with the greatest needs, regardless of insurance status. BHSA requires counties to make a good faith effort to pursue reimbursement from commercial plans and Medi-Cal managed care plans when providing covered services to individuals. DHCS is collaborating with the Department of Managed Health Care (DMHC) to ensure commercial payors appropriately reimburse for eligible services. Coordination with Medi-Cal and other insurers is important, but BHSA funding is not limited to Medi-Cal members and/or those with some form of insurance.
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Myth: The BHSA does not support culturally responsive services.
Reality: Cultural responsiveness is not optional under the BHSA. It is a mandated component of service delivery.
The BHSA continues California’s commitment to providing services that are culturally and linguistically competent and responsive. Effective behavioral health care must be tailored to the specific needs of diverse communities. Counties are required to engage with stakeholders and incorporate cultural considerations into their planning and service delivery.
Under the BHSA, each county is required to ensure its county-operated and county-contracted behavioral health workforce is culturally and linguistically competent and can meet the needs of the population to be served. Counties must ensure that their BHSA-funded providers comply with all nondiscrimination requirements and deliver services in a culturally competent manner.
Beyond requiring cultural responsiveness, the BHSA also introduces accountability by linking reduction of identified disparities to outcomes reporting in the upcoming Behavioral Health Outcomes Accountability and Transparency Report (BHOATR). Counties must show measurable progress in reducing disparities, not just commit to culturally responsive planning.
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Myth: Proposition 1 will force counties to cut Full Service Partnership (FSP) programs and serve fewer people because counties can't meet program fidelity standards.
Reality: The BHSA will support FSP programs to align with evidence-based standards and, in turn, will improve service delivery and outcomes.
The BHSA requires counties to implement Assertive Community Treatment (ACT), Forensic ACT (FACT), the Individual Placement and Support (IPS) model of Supported Employment, High Fidelity Wraparound (HFW), and Assertive Field-Based Initiation for SUD Services as required parts of FSP programs.
As noted in the Mental Health Services Oversight and Accountability Commission’s 2023 Report to the Legislature on Full Service Partnerships, “FSP programs under the MHSA are team-based and recovery-focused, typically based on intensive case management or assertive community treatment (ACT)… Early evidence on the effectiveness of FSPs suggests that these programs, when implemented with fidelity, can reduce hospitalizations, criminal justice contacts, and improve housing stability for consumers with severe and persistent mental illness.” (emphasis added)
The BHSA supports fidelity implementation for services that are the cornerstone of FSP programs and are scientifically proven to improve outcomes for Californians experiencing the greatest inequities, including children and youth involved in child welfare, individuals with lived experience with the criminal justice system, individuals living with significant medical and substance use comorbidity, and individuals at risk of or experiencing homelessness. These services have been available in some form across the state at different points in time, but they are not widely available or consistently delivered with fidelity to the evidence-based models. This means FSP programs have not been delivered at the intensity level or using the multidisciplinary team-based care models that are widely demonstrated to improve outcomes, improve quality of life, and ensure that individuals can remain and thrive independently in the community.
In addition, historically, FSP programs have not always prioritized individuals living with the most complex needs. Instead, FSP program slots were sometimes used for individuals to cover their rent or for individuals who needed ongoing support, such as case management or peer support services, but not intensive care. Restructuring FSP programs will ensure that FSP slots prioritize individuals living with the most significant and complex needs that cannot be met through other programs, while other BHSA programs, including Housing Intervention programs, can be utilized for individuals with less complex behavioral health needs.
Strengthening FSP programs to align with evidence-based standards takes time. Counties will not be held to fidelity standards for ACT, FACT, IPS, and HFW for the first three-year Integrated Plan. This initial Integrated Plan period should be used to meet with Centers of Excellence (COEs) for these services, assess where adjustments need to be made, and take active steps in aligning FSP programs with fidelity standards. COEs will provide training, technical assistance, and fidelity support to county FSP programs free of charge, ensuring county funds can be used to implement services. Adherence to fidelity standards will begin with the second Integrated Plan beginning in FY 2029-2030.
Finally, counties will be required to deploy Assertive Field-Based Initiation programs that proactively engage individuals living with SUD and offer low barrier access to medications for addiction treatment (MAT). Assertive Field-Based Initiation promotes a proactive “no-wrong door” approach to connect more individuals living with SUD to MAT on a voluntary basis, thereby increasing access to life-saving medication, reducing overdoses, and engaging Californians in their recovery journey.
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Myth: There is not enough funding to implement evidence-based services with fidelity.
Reality: Counties have access to significant federal funding to support implementation of evidence-based services with fidelity. For example, new Medi-Cal funding is available for ACT, FACT, IPS, CSC for FEP, and HFW, and SAMHSA and Opioid Settlement Fund funding is available for the Assertive Field-Based Initiation for SUD Treatment Services.
ACT, FACT, IPS, and CSC for FEP are currently covered under Medi-Cal with bundled monthly rates for counties that opt in to service coverage under BH-CONNECT2. DHCS collaborated intensively with the California Behavioral Health Directors Association (CBHDA), the California Mental Health Services Authority (CalMHSA), and counties during the rate-setting process for these services to ensure that payment rates reflect comprehensive clinical and programmatic considerations. Under CalAIM Behavioral Health payment reform, Medi-Cal rates are comparable with industry standards, and in the case of outpatient rates, are significantly higher—including higher than commercial and Medicare rates. The Medi-Cal rates for ACT, FACT, IPS, and CSC for FEP are similarly robust. Counties have access to payment rates that are more than sufficient to implement these evidence-based services with fidelity. Interested stakeholders and providers should refer to a letter sent to county behavioral health directors to learn more about the Medi-Cal behavioral health rate-setting process and the flexibilities available to counties for strategic implementation.
Further, COEs will provide training, technical assistance, and fidelity support to counties and providers in establishing evidence-based services free of charge, ensuring county funds can be used to implement services.
Additionally, the BH-CONNECT Access, Reform and Outcomes Incentive Program includes $1.9 billion for counties to increase utilization of and access to Medi-Cal services, including ACT, FACT, IPS, CSC for FEP, and HFW. Forty-five counties are participating in the program and will be eligible to earn funds they can use to support fidelity implementation of these services, further reducing the financial burden for counties and providing additional federal funding to counties to start delivering these services.
While counties are required to expend BHSA funds for the Assertive Field-Based Initiation for Substance Use Disorder Treatment Services EBP, other funding sources may supplement BHSA efforts. These funding sources include Medi-Cal, SAMHSA, and Opioid Settlement Funding.
For more information see:
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BHIN 25-009 to learn more about Medi-Cal coverage of evidence-based practices
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COE Resource Hub to learn more about the role of COEs and services offered
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BHIN 25-006 to learn more about the Incentive Program
Myth: The requirement to spend 30% of BHSA funding on Housing Interventions reduces funding available for other needed behavioral health services.
Reality: Housing is integral to behavioral health recovery.
Nearly half (48%) of people experiencing homelessness in California are living with complex behavioral health needs.3, 4 , When excluding individuals living with a substance use disorder, 22% of people experiencing homelessness nationally are living with a Serious Mental Illness.5 Additionally, individuals living with complex behavioral health needs in California were over twice as likely to have entered their current episode of homelessness from an institutional setting (e.g., jail, prison, residential drug treatment setting) as those who did not meet the criteria (27% versus 12%). However, robust data demonstrate that individuals living with significant behavioral health needs (with or without co-occurring substance use disorders) have better outcomes when placed in permanent housing that is combined with supportive services, such as through programs like ACT and Intensive Case Management (ICM).6, 7 , For example, a randomized control trial in Santa Clara County found that permanent housing combined with ACT or ICM is associated with increases in housing placement, housing retention, outpatient mental health service utilization, and decreases in psychiatric-related emergency department utilization among individuals with the most acute needs.8
Reality: The BHSA offers counties flexibility to meet their local service and housing needs.
Counties may request to transfer up to seven percent out of their 30 percent BHSA Housing Interventions allocation into Full Service Partnership or Behavioral Health Services and Supports and transfer up to 14 percent into their 30 percent BHSA Housing Interventions allocation. However, if a county uses Housing Intervention funds to provide outreach and engagement, the amount of funds the county can transfer out of Housing Interventions must be decreased by a corresponding amount. Counties with a population of less than 200,000 may request an exemption beyond the transfer allowance in their Integrated Plan for Fiscal Years 2026–2029 and 2029–2032 and all counties regardless of size may do so beginning with the Integrated Plan for Fiscal Years 2032–2035.
Reality: Medi-Cal Community Supports address Medi-Cal members’ health-related social needs and are covered by Managed Care Plans, freeing up BHSA dollars and expanding the breadth of services for Californians.
Historically, services that addressed health-related social needs were funded under MHSA. In 2022, the launch of CalAIM brought many reforms to the delivery system, including the launch of the Enhanced Care Management (ECM) benefit and a list of 14 Community Supports that have been covered by MCPs since that time. With services including, but not limited to, Transitional Rent, Housing Tenancy and Sustaining Services, and Housing Deposits covered by MCPs, this has “freed up” dollars that counties historically spent under MHSA, thus allowing more flexibility and available funds under BHSA.
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