All right, so good morning.

I like to call to order the order supervisors health committee for May 11th.

Clerk take the roll.

Supervisor Cam.

Present.

Supervisor Miley.

Present.

We have a quorum.

Alrighty.

Would the clerk like to provide any instructions for public participation?

Sure, thanks.

For all participants, please state your name for the record prior to your presentation.

If you wish to speak on an item not on the agenda, please wait until Chair Miley calls for public input on non-agendized items.

Only matters, but then the committee's jurisdiction may be addressed to notify the clerk you wish to speak for in-person participants.

Please fill out a speaker card and hand it to the clerk.

The speaker cards are at the back of the room, and I am the clerk for online participants.

Please use the raise hand function when we are on item that you wish to comment on.

For dialed in participants, please dial star nine to use the raise hand function.

Dialing it again allows you to lower your hand.

The clerk will call your name when it is time for public comment.

If you are in person, please come to the podium to speak.

If you are online or dialed in, the clerk will call your name and allow you to unmute.

That concludes the clerk instructions for public comment.

Thank you.

All right, thank you.

So those who um can will you please join me in the Pledge of Allegiance?

Yes.

Pledge allegiance to the flag.

One nation under God, invisible, liberty, justice for all.

All right.

This morning, all right.

We've got two action items.

We'll be taking public comment after we complete both items one A and one B.

Um good morning, Chair Miley and Supervisor Tam.

Thank you for the opportunity to present our proposition one VHSA plan.

My name is Dr.

Karen Tribble.

I'm the behavioral health director on Alameda County, and there's a couple of context that I'd like to present to you for your consideration and understand as we walk through the process.

I'm joined today by uh Vanessa Baker, Deputy Director, Plan Administrator, and our uh image or BHSA Division Director Tracy Hazleton.

So there's a lot of information which we hope to give you and very important context is this is the first three-year plan where Prop One has transitioned from MHSA to BHSA.

What is also important to note, and this is something we've already gotten lots of uh public comment on is there is an error in the state's template statewide for calculations.

So it doubles the amount that is in our carryover.

So for example, it shows a 40 million dollar addition and in our template as well as a 18 million dollar in some other components.

Now, what we are trying to show you, and the state is working with everyone.

But they have notified counties and they have asked us to use another feedback.

So essentially for those uh constituents who I believe you also probably have heard of, is that there's more calculation that would be true if the actual calculations were correct.

So what we think is going to be about a between 20 to 25 million dollar reduction in our carryover, nevertheless, because we've been planning on actual like extrapolated numbers and we've been working with our finance and our team and our leadership as well as state uh consultants.

So we are more on track and more aligned with what that will actually be.

So we'll provide more information when we get to that section, but I wanted to call that out to you.

Um and the other piece to acknowledge is although the state is revising the template and will require that all counties resubmit um by or um in a few weeks, June 14th.

Actually, this week, everyone will have to resubmit with the actual corrected numbers.

Um, we'll be coming back to your board, we hope, barring any issue back on June 16th.

So it will have to go through the process again once we survive uh provide the revised information, make the programmatic adjustments that the state as well as correct the numbers in our carryover.

Um typically, even if the state is now correcting that number, what we typically will see is the increased revenues that we may look for if, quite frankly, if more millionaires um provide more funding into it, is that typically the state is still slightly behind in the distribution of funds.

At one year, for example, in 2020, we got 40 million dollars in the last quarter.

That in and uh we couldn't spend it in time or our providers.

So I say that to say what we're what we'll talk about when we get to that section is our time and our approach to hold steady our providers despite some of the fluctuations that the state is now wrestling with.

And so we're very pleased with that.

So more information to follow, but I would acknowledge this is our first three year plan, and we hope to hear any questions or comments from you or members of the public.

So for now I will defer to uh Deputy Director uh Vanessa Baker.

Thank you, Dr.

Tribble, and good morning, Chair Miley and Supervisor Tam.

So, next slide, please.

Why are we here today?

So we're here to provide the Board of Supervisors Health Committee with information about the program and fiscal inclusions in the draft behavioral health services act three-year integrated plan.

And that's a new term integrated plan, and we will provide you with a lot more information about what that means.

So again, the three year period is 26, 27, and then 28, 29.

So it covers those periods.

And then, of course, we ultimately will be requesting the health committee recommend that the draft three-year plan be moved to the full board uh calendar for approval.

Next slide, please.

So what we will be discussing today, again, I will provide just general a quick review and system impacts just to help level set and remind everyone of the Behavioral Health Services Act under Proposition One.

Then we will focus on two pieces of the integrated, well, the full integrated plan, which includes information about the services, so treatment, who the populations are, the changes, and then, of course, we will be providing you with information about the budget, which is really critical.

And then we'll talk about Alameda County specific updates, so how we're implementing what this transition will look like.

I know you have information about that, you've heard it, but if you're like me, hearing it again and again is incredibly helpful.

And then key to this process, we will discuss the timeline, and then ultimately we will provide you with resources for individuals online and in the room to access more information about the Behavioral Health Services Act.

Next slide, please.

So now I will tell you a little bit about just the overview.

So again, as a reminder, the Mental Health Services Act and the Behavioral Health Services Act, they created a 1% tax on incomes in excess of 1 million dollars.

And under MHSA, it was to expand Mental Health Services Act or Mental Health Services, excuse me.

Under BHSA, and we'll talk about that a little bit more, it is more inclusive of mental health and substance use.

So what does this look like in terms of revenue?

So in 2023, that included 120,000 tax returns, 0.7%.

So that is how we received this revenue in 2023.

Now, the bottom bullets is a lot of detail, but just to cover it very briefly, of course, jumping down to the fourth bullet, we're looking at two years prior.

Okay, so the way that the state manages this is they basically set aside 1.76 of all personal income tax payments to prepare and plan for the future payments.

But then, of course, there's an adjustment because those personal income taxes, not everyone receives an income over 1 million.

So then there has to be an adjustment.

And what this translates to is this revenue is incredibly volatile.

So the state does a decent job.

I will say that we do a very good job at these predictions and trying to plan, but this is incredibly important and relevant to this presentation today.

So again, then finally, there is a settlement, the initial personal income tax payments, and then the actual tax returns.

Next slide, please.

So what is the purpose of the Behavioral Health Services Act?

So here's where I will share a little bit about essentially the shift from MHSA to BHSA.

So in March 2024, we passed proposition one.

And proposition one includes two key elements the Behavioral Health Services Act, which we're talking about today, and then the 6.4 billion behavioral health bond, and that is to support housing.

And both are really focused on providing services to those individuals with the most significant mental health and substance use disorder needs.

And that is key because proposition one is a philosophical shift.

Under MHSA, there was a lot of focus on prevention, intervention, treatment across the spectrum.

So prior to those at risk all the way up to the most severely ill.

But BHSA is focused on those who are the most severely mentally ill.

So that's where much of the change has taken place.

And of course, a really positive piece is the inclusion of eligible programming for those with substance use conditions.

And then, of course, there is a new focus on housing and housing interventions because I think we can all see that that's a significant need in our state.

So looking at the arrow and what we're moving toward, the goal is to expand access.

And then the middle or the second bullet there, prioritize billable services.

And this is very, very important because billable medical services, this is a high priority.

The state will be reviewing, auditing.

There is a high expectation that providers bill as many services as possible.

And then, of course, the funds must be directed to the most in need.

And then in 2029, to the far right, counties will be given billable service benchmarks to attain and maintain.

So that's we're something we're looking forward to, but also something we need to really position ourselves well for in terms of the billable services.

Next slide, please.

This is a busy slide, but the important piece here is just really looking at the flow.

So starting on the left, the light purple, MHSA, and I covered this a little bit, covered the spectrum of illness from prevention all the way up to the most severe, and it was upstream.

Now, as of July of this year, so we're talking two months, actually less than two months, we have this shift.

And so it's downstream and more severe.

Targets individuals, and you'll see it's in bold, severe.

We can't say it enough, severe mental illness, substance use, and there's a focus on housing, resources, navigation, and subsidies.

So really that that whole scope of services for those most severely impacted.

Next slide, please.

And this is my final slide.

And I think you've all seen this type of slide before.

We provide these elements, or sometimes referred to as buckets, but essentially under MHSA, there were five, and here we have four, but really we're looking at three.

And so I'll take you to the right, the state administrative funds at 10%.

The state takes 10% off the top of our revenue allocation prior to us receiving that revenue.

So then we have the three remaining elements.

So starting on the left, housing at 30%, it's a 30% allocation of that remaining revenue, and then our full service partnerships element, which is our highest level, most intensive outpatient service.

It's evidence-based at 35%.

And then what we sometimes can refer to as the everything else or the all-inclusive element, the behavioral health services and supports at 35%.

And then following the lime green arrow, you will see that further, if you dig down deeper at a granular level, there are further requirements within the behavioral health services and supports.

Those funds must be used for children and youth 25 years of age or younger.

So that's really important because as we plan, we are required to meet these requirements, and we work with our community to find ways to meet all of these needs and stay within the regulatory requirements.

And at this point, I will pass the mic to my colleague, Tracy Hazleton.

Thank you.

Good morning, supervisors.

So I am going to cover some areas of system impacts as well as some changes or technical pieces around the Behavioral Health Services Act.

Next slide.

So as Vanessa was talking about the changes in terms of the categories and the shifts in focus, these are the repercussions that our department is taking in terms of changing in our budget.

And these are again based on the changes in the allocation that is coming to the county as well as the new regulatory changes that are coming.

I won't read the entire column.

We have shown this slide before in previous presentations.

It represents approximately 53 million in changes to our budget.

I will just highlight a few of the items here.

So areas that are that we will be making reductions or terminations.

The largest area here you can see is around age specific services to early childhood, child youth, transition age youth, adults or older adults programming.

There will also be a significant change to our preventative services.

As we have mentioned before, those are no longer available to be funded at the local level.

They will be realigned to the state.

We are still waiting for the California Department of Public Health to release information around their grant process.

That information is still not out yet.

And then another area that has been realigned to the state, you can see here where we have made reductions is around workforce education and training.

Per new regulations, we at the county level are not allowed to duplicate what the state will be doing in terms of workforce education and training.

And so the state will be taking on areas in terms of loan assumption and other training and workforce initiatives.

So we are reducing those activities at the local level.

Next slide.

So these are based on new regulatory requirements under BHSA and just fiscal changes.

These are some client and beneficiary impacts we wanted to highlight.

So with the elimination of prevention programming, that affects approximately 13,000 beneficiaries that we have either served or touched with prevention services.

So this will be an increase in access for our individuals who need substance use services.

We are developing a new early intervention system of care.

So we did offer 18 programs that were previously under prevention and early intervention that met the requirements for early intervention.

We did offer that opportunity to transition them to our new system of care.

So this will increase services to approximately over 800 beneficiaries.

And then we also are partnering with our Alameda County Health Agency, HH housing and homelessness around a countywide flexible housing subsidy pool.

This will increase access to permanent supportive housing for individuals in the county.

And the other area that I just spoke about around workforce education and training, this will be a loss of locally directed programming.

There still will be programming at the state, but for us in this county who did quite a bit of local workforce education and training, particularly around loan repayment and internship fiscal support, this will be a loss for us at the local level.

And individuals in our county will need to compete at a statewide level for those resources.

Next slide.

So something also to highlight that is new with BHSA is there are new reporting requirements.

So as we are here today, we are talking about the integrated plan.

And so this will reduce the transparency, we think at the county level of information, the way it is described at the county level.

And so there will still be information around accessing local needs, outlining local goals, and then developing strategies and expenditures.

The second report that will be required is called the Behavioral Health Outcomes Accountability and Transparency Report.

We don't know what this report looks like.

A draft will be out this summer for counties to look at.

This will be tracking service utilization.

So how much are we doing in terms of services in a variety of all of our service modalities, as well as tracking expenditures and then looking at access and impact on our planned goals.

So the integrated plan on the left will be a planning document, and then the voter will be assessing how did we do with our planning?

And so more information will be coming.

The voter will also be coming to the health committee when that report has been developed.

And also, as Vanessa had mentioned about Medi-Cal benchmarks in the voter is where you will see the Medi-Cal benchmark information.

And so this is just an example for the public to understand the difference between the MHSA plan and this new BHSA integrated plan.

And on the left, you'll see uh information on the MHSA plan.

It was a much more flexible plan.

And counties were able, every county was able to produce their plan as uh was helpful for their own community.

And now the integrated plan, it is actually a portal that counties have to report information into, and then at the end, a county can actually hit a download button, and then a what looks almost like a survey response plan is what then uh the county gets to be able to highlight to the community.

So the actual plan document looks very different and is not as easy to read, and that's because the information is going through a portal and then is being downloaded.

The other highlight I just want to say is that within the MHSA plan, it was just highlighting or documenting the MHSA funding stream, whereas in the BHSA integrated plan, it does reflect the budget reflects all county behavioral health funding streams.

And so to be able to describe the broader system that the county is overseeing, including mental health substance use, housing, and workforce.

Okay, next slide.

So these are areas just a highlight of what you'll see in the integrated draft plan.

These are a number of the areas you'll still see a significant section around the community planning process, as well as a new section I'm going to highlight in a minute around the behavioral health goals and metrics that go along with these statewide behavioral health goals.

Next slide.

So within the BHSA plan, there still is a requirement for a robust community planning process or CPP.

So here is information around our CPP process.

It took place between January 1st to May.

We collected 613 surveys.

That's about the same amount we did last year.

We conducted 35 listening sessions for 355 participants.

That's roughly the same as last year.

It's a slightly less number of participants, same number of listening sessions.

Something that is important to highlight is we now have to target 24 different stakeholder groups and 10 different or five different diverse state viewpoints.

So there's many more stakeholder groups that we are required to target to gather feedback around a county needs.

So the top system needs continued to be access, coordination, and navigation for both mental health and substance use services, following by crisis services and then housing.

For population needs, the needs of children, youth, and TA were the number one population need ranked by the community, followed by adults and older adults.

I would say these both of these system and population needs, they have been the similar ranking for the last few years.

That access, coordination, navigation has been the top system need, and then the needs of children, youth, and tay have been the top population need.

Okay, next slide.

This is again something different that the state will be having counties focus on.

There are 14 new behavioral health goals that the state is looking at counties to track and uplift.

There are six priority behavioral health goals.

You can see them here.

They have a little star next to them, access to care, untreated behavioral health conditions, institutionalization, homelessness, justice involvement, and removal of children from the home.

Again, the state is asking counties to focus on these six priority goals, and then they had each county choose a seventh goal to focus on.

Our county chose overdoses as the seventh goal.

And this is because we are doing quite a bit of work with our opioid settlement funding around overdoses.

And it is a one of the behavioral health goals that we in county behavioral health, we feel like we can have some control over in terms of increases and improvements around.

These behavioral health goals and the metrics that are behind these goals, these are being driven by a state commission called the Quality can go and look at.

If you would like to learn more about the COIAC, these committee meetings are public.

There is where, again, metrics are being developed around each of these 14 goals that counties will be then reporting on in the future.

Next slide.

So within the BHSA integrated plan, there is information on the three new components.

So of the first component around housing interventions.

This is 30% of the funding.

And as you can see on the left, there is a definition here of the housing interventions.

They include rental subsidies, operating subsidies, shared housing, family housing, as well as the non-federal share of certain pieces of transitional rent.

Half of the funding must be prioritized for individuals who are chronically homeless.

And then this is not a requirement, but if a county chooses to be developing new housing, you can spend up to 25% of this allocation on capital on developing new housing.

So on the right hand side on the bullets, this is how we in the county are spending these dollars at the moment.

This is bullet three around rental subsidies that we are currently subsidizing for individuals.

And then we also have participant assistant funds for individuals.

And these are things that individuals might need in order to remain housed or start in their housing journey.

It could be pots and pans, it could be their pet deposit, it could be catching up on an electricity bill, things, things like that.

And one thing I do want to highlight that we are adding to our budget is that back in 2010 when MHSA was starting.

To go along with those units that were built, there was an operating subsidy, and it was held with Cal HFA.

And this operating subsidy helped keep the building to help with maintenance with the building, help operate the building, and also keep the rent low in those units.

Those operating subsidies are being depleted.

And so we also are starting to replenish those operating subsidies with Cal HFA.

And so we have one unit you'll see in the budget when it comes in June with Clinton Commons.

And so we're going to be replenishing that operating subsidy.

And you'll see that in the budget when it comes in June.

Okay, next slide.

And this not only covers our full service partnerships, but it also covers our vocational services, and what that is called individual placement and supports or IPS.

So this gives you a sense of what this funding is covering.

We'll have two tiers of full service partnerships.

So we will have one tier of full service partnerships that are an evidence-based program.

They have specific client-to-staff ratios as well as a specific number of touches or visits per month.

And then we have a second tier called intensive case management.

And then for children, we have two programs that are called high fidelity wraparound programs.

Next slide.

35% of our allocation.

And within this component, this component is split between um treatment services and workforce, capital facilities and technology and outreach.

And then the other half is for early intervention.

So 51% of this allocation must go to early intervention services.

And then of that early intervention funding, 51% must go to children and youth.

So as you have heard quite a bit, while the state is really focusing on the severely mentally ill in terms of a focus with BHSA.

Another significant focus is early intervention.

And within that, really a focus for children and youth.

Those are the two, I would say, significant, almost not quite carve-outs, but they are specific sub-allocations that are required within the requirements.

And so that's why we are uplifting a new early intervention system of care within BHSA.

Okay, next slide.

So we did finish our public comment period.

Sometimes when we come to the board at this stage, we have we have finished public comment, and sometimes we have the comments available, sometimes we don't.

And so we have finished our public comment period here from March 19th through Monday, April 20th.

We had 103 public comments.

This is the most ever.

So we do uh feel excited and interested that we are getting engagement from the community around uh the new BHSA integrated plan and the new regulations with BHSA.

We collected public comments through an online survey, listening sessions, and the public hearing.

So we had our public hearing at the Behavioral Health Advisory Board on April 20th.

And when we looked around the room and the number of people online, we had 109 people attend.

Public comment was distributed in English, Chinese, Farsi, Spanish, Tagalog, and Vietnamese, all of our threshold languages.

And then the way that the state is now requiring us to track public comment, we have to track it by stakeholder group as well as by type of public comment.

So you can see both on the left, these are the types of stakeholder groups that made public comments, and then on the right, you can see the uh theme of the comments that were made.

Right, next slide.

And so with that, I am going to hand it back to Dr.

Tribble.

She is going to go through our finance section, and then I will come back to talk about some resources and some next steps.

Thank you, Tracy.

If you can go back to the prior slide, that would be helpful.

I just want to synthesize a little bit of information for the supervisors and public as well.

Um, as you saw, for example, in uh slide 17, we don't have to go back, it talked about statewide goals.

What's important to note is there is a component that's part of the BHSA section.

So all of the funded programs have to lead up to the botar to meet those statewide goals.

And the count the state is expecting that the counties will also contribute.

So some of the data and the feed and the information is Tracy mentioned, for example, out of home placement housing or other areas are outside of county behavioral health departments.

So they're looking at counties as a whole, and so that's important to note.

The other piece is to this come up in public comment as well in questions when the uh term integrated plan, the state uh references that, but they're really talking about how does a behavioral health system integrate its funding and what does it look like countywide.

So that is also why the state will be looking very clearly with what counties spend their dollars on for behavioral health, period, whether it's BHSA funded or whether it's other funding sources.

Um, the other piece is as uh Tracy mentioned, there also will be, besides the BHSA related data components beginning in January.

If a program does not bill Medi-Cal, we will have to provide feedback based on what the state develops to key required data elements.

In other words, uh BHSA has certain data elements that'll be required, but the state is now saying behavioral health departments, we want to track in general how you all spend your money, and there will be expectations for those that receive whether it's realignment dollars, county general fund, anything that passes through behavioral health departments, there will come a requirement to have more access and information key elements.

So really the state is truly looking at behavioral health departments to provide data to them so they can analyze system-wide impacts and how the state is doing in general for behavior health.

Again, something very important to note.

So as we move in the future, you will hear probably in the next several months, it is a uh requirement or a technical ability for people to begin in counties to begin July 1st.

We will likely not.

We will wait till January 1st.

There's so much change before we then provide information through our provider network.

So that's important to note.

I wanted to just again synthesize what that means.

As we move to this next stage, I want to also talk about some really key information besides what you see on the slide.

Next slide, thank you.

So this again is based on our county process at the time that was information is available to us.

Obviously, the budget information is subject to county review and approval and is obviously subject to change.

But this is apparently where we are right now.

20% of the budget will be BHSA.

In terms of where BHSA revenue is, is that it's at about 164 million dollars.

And so that is a representative of a 27% rut reduction from our budget of last year.

So again, there are lots of questions around how the department, how the county gets to these figures, but this is essentially where our budget estimates lie.

And as I mentioned before, although the county, all counties statewide will be providing revised information based on the templates that the state will change, essentially, this still represents a significant delta.

Our estimated uh revenue in terms of the money that we believe actually will come in, as you can see, is different than the budget.

So we are still planning to hold as many program services as we possibly can.

When I get to the carryover slide, I want to show that.

Um, as you may recall, in years past, uh, your board had directed us to close the delta between what our budget is and revenue.

So we don't have so much carryover.

The wonderful thing is in Alameda County, we have never given back refund uh it's not refunds, but uh given back to the state.

That's wonderful.

We've used it.

Our providers have been active and we've had mechanisms to pay them.

Um, on the other hand, this now is still an issue, and so with the significant cuts, we still did not have a one-to-one correlation between the revenue and the budget.

That would have resulted in more reductions.

So there is still our ability to carry over programs based on revenue or or unspent dollars or carryover.

So, as you can see, uh our uh department did give up positions.

We removed them from the MOE process.

Uh, we believe it's that important enough that as hard as that is, our all of our leaders decided that all of our systems could and should help support the process.

So we gave up positions uh to help with the provider Delta.

We also initially planned for one year only, but we were able to uh and I'll show in the future slides in our planning, we believe that there may be an opportunity there.

Now, what's important to note is the state says for one year only uh can you use MHSA revenue?

So that's important.

As Tracy mentioned, the components are changing.

So again, when you see one year, that means the state says you have to spend the money that you had left over from MHSA this coming fiscal year.

In the future years, the BHSA carryover may be utilized in different ways.

And again, Tracy is probably a resident expert and could give more information if there are questions around that, but that's important to know.

And this third bullet is what I mentioned before, where we always will see late payments come through.

And so, as I mentioned before, they have been as high as 40 million dollars where we've gotten payments in the third quarter, which did not allow providers or anyone to spend those dollars.

So we still think that's going to happen even this year as we move forward.

We don't know that it will it clearly won't be 40 million, but we are already planning to use that to carry us through.

And then finally, thankfully, your board has approved measure W funds at this point for $4 million.

So we'll be using that.

Everything that you'll hear in our next budget session is separate, is particularly specific to our BHSA plan.

So I do know that Director Chowdry will be going through the a bridge and proposal and process, but we're required to inform you specifically on BHSA first.

So that's why the revenues don't include any proposals or anything in that sense.

Next slide.

So here we wanted to make sure we are transparent and we stay committed to what we presented before.

So these are some of the figures that we shared publicly.

We were very transparent.

We've been planning for two years for this process.

And so this is a test, an example slide essentially of the dollars that we were working toward.

What's important to note here that I think you will see is that we have had some questions as to did you add more dollars in terms of your housing interventions and what did that play out.

Some advocating for more, obviously, many some advocating to not, given what there are other resources in the available in the county.

But one thing to note is Alameda County, probably since the 80s has actually led the process of housing and related subsidies statewide.

This just how Alameda County has moved its process.

So we actually had way more housing dollars, and as Tracy mentioned, something that was transferred into 2010.

So it's been for decades that Alamity County has done this.

So we really didn't have to add more dollars there.

And in fact, we actually made sure that other program and capital programs were paid for and supported.

That's how our housing intervention remained uh that component remained relatively stable.

Uh one piece to note also in the plan, it does require uh that, as you heard before the BCHIP uh bond B chip that process and the CCE.

So to tie it all together is again, we're very grateful for the capital funding, so that's why there's not much there related to capital, is we were very aggressive in Alameda County and got down 170 million dollars worth of buildings for behavioral health and substance use and mental health-related programs, and then about 120 million and community care expansion, and that's housing.

So, again, not a lot of housing capital is needed there.

If you look to the right, and I'll speak to the red sections later, for our full service partnerships, we also had been expanded the number of FSPs.

We did not need to increase.

So in March, we believe would be on track.

And in fact, we we can't decrease uh because of some of the legal and other ethical and system requirements that we're working on.

So the right is essentially where most of our community partners and our providers and the county is impacted.

And at that time, we believed by making approximately 52.7 million dollars of reductions, that it would at least allow us to to some degree salvage as much of a safety system as possible.

There have been lots of questions again, and just to reiterate for public record, our plan has unfortunately based on this, and again, this is an exclusion of any pending measure W questions, uh it wasn't necessarily based on whether or not the program was needed.

We did need many of the programs.

We certainly just did not have the revenue to sustain them.

So as you can see, the delta that we expected was around 23 million dollars.

The state, as we have been speaking to previously, provided adjusted revenue estimates, and then it went lower than that.

It said you would have a 1.8 million dollar delta in housing, 5.5 million dollar delta in FSP, and about a 25 as opposed to 23 million dollar delta.

Even with that, the strategies that I mentioned on the preceding slides, we felt very confident and still feel confident that we could still sustain our plan and the services and ports that we have that we have uh offered to your board as well to consider.

Next slide, please.

Now, this is a snapshot of uh literally, so that we really want to help people to understand what is in the integrated plan.

The first thing I will say is this will not be the same when we resubmit uh based on the change in the template, and this is also where some of the errors came up for the from the state.

Again, every county went through it, but at least this is a snapshot on some of those figures.

So if you if you look at the far left, it shows essentially the state developed a way to show these are the categories that we saw before under MHSA, they don't exist anymore.

And then we had to show how we would then transfer to sustain them.

Now, one thing is interesting.

If you look at the very bottom slide, um bless you.

What this what is most important to note is that the carryover will need to sustain you for three years.

That was not apparent, and there were some calculation errors, as I mentioned in the template that showed we had an additional, it doubled the amounts that you see for particularly uh the 10 million dollars as well of the uh and and the nine million.

So it's just several errors in the calculation.

This slide is accurate to help understand it whether or not the other source data is in is erroneous.

So if you look at the first year, it lined up by category.

So we were we transferred about 10 million dollars to our full service partnership.

Again, not only because of the service, as you know, Care Court has been very successful, recognized by the state, that is the most um prominent type of service line that used that we use to pay for Care Court.

So we did obviously need to continue that.

There are also uh settlement agreements that the county has entered into that speak to the number of full service partnerships.

So we also have to make sure we maintain those levels and are consistent.

So if you look to the right, it shows that dollar amount, and this is essentially a breakdown.

What was not easy to notice is that again it is spread across years.

So year one, uh, presumably, this is an estimate.

Again, we'll see what revisions come out, but about 8.5 million will be transferred to the FSP to make sure we can sustain the full service partnership programs.

Year two, about 1.5 million.

Year three, there will be no more carryover based on projections that we will carry over.

So essentially, our hope is that our revenues in three years, which again technically is four years off, will be able to sustain it without issue.

Either way, based on our programming, we think we should be okay, and we hope that everything will pan out well, but we are again subject to how many millionaires opt to take advantage of as many federal level tax reductions.

So again, it is something that we can't predict.

If you look to the right, that largest component was the largest uh number of dollars cut.

Year one, we're transferring 37 million approximately.

Year two, we're gonna be transferring about 21 million, and year three about nine million.

So this means of the program and the planning that we had done, we plan to sustain them.

So essentially, what we did was created a three-year bridge to make sure that we do not uh lose at least the programs that are in our plan now.

So that is how we're we're fairly confident we will be able to use that.

The state has not opined on whether this is a uh a strategy they won't accept.

Instead, they have acknowledged that the calculations are incorrect.

So we're very hopeful that we will be able to do that.

But that is really important to note.

Next slide.

So when you compare it to our estimates, this is just basically what we mentioned before.

This is essentially the the true up in uh lower case levels.

Obviously, the state is still working on how to true that up, but that is how we uh got to that point.

So by using our planning framework, we will be able to move forward on this kind of a bridge process based on what we had looked at.

This is how we've been looking at a multi-year opportunity to support the programs that are in the plan.

So if there is more revenue, if there are less spending, that will add to our carryover amount, and we will have more money to sustain our programs in the absence of an increased amount of revenue, for example.

Next slide.

This is comparing again our budget.

So if you look to the far left, this is our 25-26 MHSA plan.

And as you can see, there it's color-coded.

The top represents our innovations funding.

There, that is no longer a component.

So essentially, if counties create pilot programs, it is on them to sustain it, to move it through the process, and it's included in our essentially our BHSS component.

If you see the PEI program, that was about $26 million.

And I'll stop there and again, just to reorient of the $26 million, as Tracy mentioned, we were able to move over providers in our prevention and early intervention to the tune of essentially now just having about a $6 million delta.

So between $16 to $18 million in prevention like programs, we'll be able to transition.

What's also important to note, and I really want to underscore and synthesize what my colleagues mentioned is that although the state is now prioritizing billing, we already know there is an impact of HR1.

There will be no conceivable way for new programs who have never really built build in that way to meet the state's expectations.

So part of our carryover is also a bridge.

We will pay for one year, we will be matching and making sure we hold their contracts so that they don't incur any revenue law.

So if you have a contract of $300,000 and you're doing prevention and early intervention, whether or not you can meet the state satisfactory transition.

So that is something that the prevention and early intervention providers will be uh supported through based on our planning.

We do know that this is slightly novel.

We've gotten feedback from our county sisters and brothers, and we're not necessarily happy about that because oftentimes our providers and other counties asked, Well, they do the same thing, but we thought this was the right thing to do given this huge changes that we're having.

If you look at the BHSS, uh the light green category, so those services essentially represented about 128 in our prior um MHSA plan, and housing was about a 25 million dollar part of our budget, and then the FSP represented about a 43.

So if you just look to the right, that shows essentially what's in the balance the breakdown of the 164.47 million dollar budget.

And again, we're trying to break down exactly so you see where the dollars come from and what there be what they will be spent on.

And as you see the color-coded, we're showing that there is going to be about $36.65 million carryover.

That's going to help us sustain those programs, as well as $8.5 million carryover for our FSPs that will also help us over the three years to sustain these programs.

What's important to note is that that $164 million does not include the prudent reserve.

And even though the economy is not as strong as one would hope it is, it does not yet meet criteria for us to tap into that.

So we also will need to use our or keep and sustain a $14 million in that prudent reserve account.

So if you look to the next slide, we also thought it was important for you to see what we beside making sure that we hold our providers into some degree of safety net transitional process over the three years, what we'll be using the carryover components for.

So the MHSA BHSA funding for the core services, that is obviously represented in the carryover components.

Everything that you see for carryover is accounted for based on those programs.

AC Health Epic, we also have contributed and will contribute $30 million dollars.

So if you um we have already pulled that out of our carryover amount in terms of our factoring and our ability to fund it, and so we are still committed to contributing from our department $31 million dollars there.

There is uh our understanding is we will need an additional uh electronic system, and it's going to cost anywhere between 12 to 20 million dollars, and we'll have to uh to make sure that our providers and others can bill and to make sure also our Santa Rita jail and our sheriff department is able to also bill to the state.

There may be an extra purchase that we very uh well believe based on our ISIC health, excuse me, AC Health IS and conversations with EPIC.

We will need to purchase.

So that again, we will hold that in our department and are prepared to pay for that for the whole uh system.

Um, there is an additional three million dollars.

We've already allocated and moved uh of the remaining 30 over the last several years for the African American well and hub, but that's in our prudent reserve, as well as that 10 to 12 million dollars of support, and that's what I refer to as the early intervention contract bridge.

Now, if there is a program or many programs that in the transition to early intervention, they bill and do a very uh fantastic job despite the budget climate, are able to reach their contract goals, then that number uh will decrease and we will have more money that we can apply.

So we'll decrease their reliance on VHSA.

But at this point, what we're hearing from our providers is that it is a very uh aggressive approach that we will have to comply with.

So we are reserving approximately that amount.

But these are examples of what you are seeing in those carryover dollars uh for the all three years.

Next slide.

So this is a breakdown.

We've tried to organize it as best we could based on the plan.

So if you look at the integrated plan that's actually posted, it's on page 232 essentially.

So this breaks down in category.

You can see to to what degree the county's quote investment is in terms of what the services are at the top that represents substance use services and those categories, and at the bottom that represents the categories relative to general quote mental health, and as you can see, uh each highlights each a slight different approach and investment given the need.

But again, I'll have to acknowledge that our goal is to uh really um show parity and increase the um equity between SUD and MHSA services, but this is the first year, so it makes sense that we do not have enough in that system to do that.

So at the bottom, housing intervention is inclusive of both mental health and SUD programs, and it crosses all across the continuum.

Next slide.

So these are also we wanted to provide uh even more clarity to you and public awareness as well as transparency.

This again shows, in terms of our county budget and and the process, this is essentially how those categories use.

And the budget for this integrated plan, again, it integrates all the funding sources for VHSA, uh, as well as our counties.

It um, these are the funding sources that I mentioned.

Any that do not bill or uh MH, excuse me, Medi-Cal will be the ones that I mentioned in January, that those contracts will to some degree will have to gather data from them.

So we hope that at least some of the data elements we have available to them.

If it is not, and the state releases more aggressive data requirements, then those programs that are funded by non-Medi-Cal revenue generated programs will have to have more.

We'll have to reflect those in our contracts.

Next slide.

So obviously, we want to continue to make sure that there's information, and we're trying our best, despite as Tracy mentioned, that it is a completely different way to read our plan.

It is not a one-for-one, it is separated out, although it is as ironic that it's an integrated plan, but it's disintegrated.

So you do have to look at narrative information and cross-reference that, but again, more information is here for the public.

Next slide.

In terms of uh where we are uh for the next several months, as I mentioned before, we may have uh state impacts based on the change in um whatever their data formulation, we'll be looking at that.

We'll be looking at the revenue.

We will also be finalizing, we will make the adjustments.

The state has required all counties to turn in with the corrected uh revenues based uh this week, I believe on the 14th is redo as as well.

Uh we'll also be looking at how the data will uh be applied across there.

Again, as I mentioned before, it won't start till January 2027, but it is a heavy lift for a provider, so we will try our best to give them technical assistance and actually inform them once we hear from the state.

We'll have to track all of the BHSA program and fiscal data for all the first three years, and we'll be doing that based on the state.

That's where the BOTAR comes in as well, and we'll be trying to make sure that we provide more and ongoing communication to you, um, our county leaders, our stakeholders and staff as this transition is uh fairly remarkable and system-changing, obviously.

Uh, and so in the absence or depending on what your board does, we will then incorporate any additional information.

So, for example, we do have the four million dollars that is included in our uh integrated plan that your board has already approved.

If any other funds are, we will have to resubmit to the state to tell them because we have to track other any other funding source, even if it's a HSA or not.

So that also you may see an adjustment there, and we will make sure we provide that as well.

Next slide.

And so here we are in terms of timeline.

Literally, we've used a very similar just for object permanence.

Uh we are hope you will approve it to go to the full board, knowing that what you're seeing will be adjusted as we get more guidance with the state, and knowing that again the revenues uh carryovers will be more modest, but we are very secure and believe that will be fine, and ultimately by June 30th, that is when we'll have to submit the final plan.

Even if there are adjustments, these are the legislatively governing uh requirements that uh dictate to when we have to submit, those will still stay the same.

Next slide, these are additional resources in terms of where our county um is going and what information is available to the process that we're looking at, and uh next slide.

And so our goal is to have recommended action from your board to allow us to move this forward to the full board of supervisors.

As soon as we hear and receive the information from the state, once they make the correction to the errors, once they post, this is what we'll be looking for.

Um, we also, as I'll just again on record, support any other action if your board chooses to take relative to other funding source, and we'll have to come back again to make sure we update that to the board.

Next slide.

So with that, I want to thank you, and uh, we have our resident experts, so I'll ask Tracy to come.

I'm sure there'll more details as well.

Thank you.

Thank you very much.

Well, thank you, Dr.

Tribble, uh, and your staff.

Umessa and Tracy and your whole team.

Um I must admit this is mind-boggling.

Yes.

Mind boggling.

Yes.

Um, you know, I have I've been an elected official for 35 years, 10 years on the city council in Oakland, 25 going on 26 years here, so more than 35 years.

I have a jurisdictorate degree.

I've been around, but this is mind-boggling.

And if you were to quiz me on this, I don't know if I'd pass.

That's okay.

We are your cliff notes.

It's okay.

So I'm just just being honest, it's quite quite a bit.

I do have a better understanding of some of the dilemmas today than I did uh prior to today.

My hope is that my colleague, supervisor Tam, who knows has background in engineering and likes numbers, uh, has a better grasp of all this.

And if she doesn't, then I'm hoping my deputy chief of staff does.

And if she doesn't, collectively, I'm hoping that some of the people I rely on, like Dr.

Dribble, you know, your doctor, Dr.

Noha, um, Nisha Becton and uh Jamie Amonza and um uh Aaron Ortiz and others can weigh in and give us a better you know grasp of all this because you've provided us with quite a bit this morning.

So with all that being said, obviously I'm hoping our agency director will be able to help us too.

With all that being said, Supervisor Tam, I'm gonna open the floor to you and then we'll go from there.

Um thank you, Chair Miley.

Uh, did you want to go through the questions and clarification that we have on this one before you go to one B?

I think we should.

I didn't realize it was going to be as complicated and detailed and thorough.

And I think we should probably focus on this for the moment just to make sure we're all clear on this piece.

And then I'm gonna go to um one B.

Okay.

Um I appreciate the complexity that um Chair Miley mentioned, because frankly, when we looked at the list that you had provided of programs that um are being shifted and transitioned from MHSA to BHSA, it's it's not very helpful to have the same nomenclature.

For example, when you say there's going to be prevention services that are no longer eligible under BHSA, but at the same time, the new statewide goal for driving change talks about reducing suicides and suicide prevention is getting cut.

So, you know, that doesn't really make a whole lot of sense.

The sentiment of many people, yes.

So uh I'm just trying to understand that, and and clearly the other issue is when you're talking about um the state's programming and the cuts that we absorb, like from 227 million down to 164 million.

Well, that's 63 million.

What is the state doing with that funding?

Are they redistributing it through uh treatment facilities that we're supposed to be eligible for?

And how are these nonprofits that are also providing, for example, some of the workforce um training, uh, how are they supposed to, especially since we locally got cut, how are they going to secure and uh kind of replenish that funding for some of their programming?

So those are the kind of issues that I'm really uh trying to grapple with in terms of the complexity, and then uh I I did have a lot of questions on uh some of the budgeting and the financing and the requirements that the state has in terms of our carryover and the 25 million dollar reduction.

Um, but perhaps you can comment on the first two.

Absolutely.

I think I will I and I I heard behind me, you heard affirmation from the audience.

That is the hello, okay.

We may have sure if you oh on the inside, yeah.

So the state believes that it can carry um statewide initiatives centering on prevention.

And it believes that by shifting the administration to public health, it will be able to provide some statewide impact.

The challenge is the math doesn't math.

Um, and I I will defer uh Director Tartan's here, but when the state did release what they would be providing to counties, it is a very small amount.

The state um believes that the source of complexity and challenge with people with behavior health issues, and when I say state, this is global.

I'm sure there may be different opinions, are occurring because of a lack of resources at the far end downstream.

So it it is just a philosophical change.

So I think I would acknowledge with you as well as I think Alameda County has done a fantastic job to invest in providers who have been superb in helping us to prevent negative outcomes, suicidality and otherwise.

But the state believes also opening it up to providers through RFPs and processes.

They believe that others can help beyond county.

Again, our county may be unique in that we had a plethora of services that were voted there.

Other counties may not have been quite so resourced.

So we are going to have the brunt of that impact.

The other piece is we have I myself have signed many, many all letters of support.

Some of the providers who are in this room, we want to affirm their ability to apply for the state.

If the state believes they will they can administer and do that, we want to support them as much as we can.

So the providers in our systems that are already coordinating, we want to do that.

So I you said it superbly.

It is going to be very, very complicated, especially if one of the goals is to reduce suicide.

We will have to watch that very carefully in our county.

In terms of uh the other piece that you mentioned, workforce education and training.

Um we are still our county still does administer uh managed care plan.

We're still in HMO for mental health and substance use.

So we still are required to train and sustain and certify providers.

The state is expecting that counties will absorb that cost.

And so absorb that cost is relative.

So what with for us that just means that we'll have a little less staff to do that work, but we still have to do it.

It does mean that we won't have as many funds to create some very, very targeted and important trainings that we do, less again, your your board uh takes action or changes or or modifies that process, but you're correct.

Um, the state also believes it can do a more effective job statewide to handle loan assumptions and things like that, as opposed to counties leading those efforts.

So that will result in a change because we could uh affirm and pay locally for people who are here in Alameda County to receive loan assumptions and all that or physication and training.

Now we will not have that ability.

It is will be the state and essentially statewide people will be competing for the same resources.

So you are correct.

So I noticed that uh, like for example, under the behavioral health services and support under the BHSA, of which we're allocating or the 35% of the funding is allocated in that category.

Um I think it's a nomenclature issue when they call it early intervention programs that provide outreach access and linkage treatment services and support when a lot of the programs that are no longer eligible do the same thing.

So, how was this communicated in in the plethora of community engagement and outreach, uh, particularly with the behavioral health collaborative, because I mean, this is kind of like they have more expertise in this than Supervisor Miley and myself.

Yes.

Uh, well, the the good thing is I I I want to affirm uh the behavior health collaborative and even those providers that are not part of that.

They're you've you've heard, I believe, for the last two years, prevention providers have come and spoken to you about that.

So we've been engaging them for the last two years.

Ergo, you have heard their feedback over these last several years about the impact.

And again, we would not disagree with their uh appraisal of what it will mean.

Um, one thing again, I would say is is it is a blessing in terms of how Alameda County has approached these prevention and these this work, but that unfortunately is now a challenge because it means we now can't fund the very programs that we built an entire system on.

Just testing, um, but I I believe uh some of the billable services, outreach and engagement services, uh, some of the treatment services.

So whether or not a provider uh perhaps uh was robust in their billing, um, in general, there that the question and concern has been how then will the county draw down Medi-Cal if it's eliminating some programs that did that?

That is the proverbial question.

That is absolutely going to be an impact.

We will not be able to draw down as much because of how Alameda County structured it.

We allowed more types of different programs to contribute to the process.

Now the state will still require that we do the work, and then they will be looking at the data, but there will be no apparent revenue source and ability to do that.

So for us, we'll be looking to help build capacity for those prevention providers that transition to prevention and early intervention.

We want to help teach them and work with them.

Some already do it, but to draw down as much as possible.

You know, they don't have slide numbers.

Oh, I guess it's 25.

Very small.

Fiscal year 2026, 27 BHS budget and revenue overview.

So the let me kind of preface some of the questions.

The 25 million dollar reduction that you're talking about because of a template error or carryover error.

Um does that put us in a position of not being able to move forward with a three year integrated plan, which we're required to do given this error until we have some firm information, or we can move forward with it, and then uh whatever corrections get um known by the state comes to us and we make adjustments accordingly.

Great question.

I think the uh there we were, I'm trying to think of a respectful word.

We saw the revenue projections in the state's uh calculations, we weren't as secure with those.

So the plan that we offered up, we're secure that we would pay for based on what we had.

Even with uh some of the carryover amount, it may um impact um this slide, for example, doesn't have the error.

There's other areas, and I I'll let Tracy speak to where they are on the plan.

But this air, this one was accurate-ish.

This one was more accurate.

Unfortunately, in other cells, they doubled some of these amounts in so the overall carryover is far inflated.

So that could have led people to believe, oh, you all didn't have to make any cuts that if we did not, for example, year one that could be true, uh, we would not be able to sustain anyone further.

Um, but it definitely we won't have much more that the state says we will uh based on the calculations.

So we're okay.

Uh it will mean that the numbers across the other parts of the plan will look slightly different, but based on the way that providers are spending, the way that we have structured it, we know that we're very confident that we can still support them over these three years, regardless of what error the state corrects, just because we were slightly uh not convinced in terms of what we were seeing.

Okay.

Um, and I don't know, Tracy, if you wanted to add we just noticed this error in the last few days and um uh highlighted this to the state.

And so we are working on an adjustment as well as other comments that the state has asked us to comment on based on the draft plan that we submitted on March 31st.

So that's why we don't have a slide on this issue, but um, you will see this in the report when it comes back to the full board uh in June.

And I would what I would say is where this error is happening is in table 10.

So if you just do the math, it's not in our slides here, but if you look in the plan um in table 10 and you do the math between the available funding and then the carryover for the next year, you can see that there's an there's an error there, and it's because the formula is pulling from different tabs in this very long budget um document, and um the state has acknowledged this error and has corrected it in the the revised budget they are requesting counties to use so it looks like at the end of three years we would have potentially um close to 40 million in carryover which I uh thought that cannot be correct based on all of the analysis work we've been doing and so when myself and finance went through and found the error it looks like we will have less than 10 million closer to three or less even at the end of the three years so um essentially the formula was double counting our carryover um from the math in that table as well as pulling it from another um tab so we're happy to explain that at another time more if you'd like and as Tracy mentioned so even with uh this is expecting that providers will uh bill and use all of their funds 3 million that has not historically been the case because of the workforce shortage and crisis and quite frankly many providers have seen this information and have preemptively altered their services so we know we will have more than the three million even with their corrections.

Yes it's it's simply a technical number at this point right in doing the a three year calculation sounds like my having to do my tax return yes yes okay um so just but as far as this table is concerned well that table that was there are you fairly confident in terms of the the year one two and three yes um entries okay yes and we are confident that we again for us this is a kind of a three year bridge that we'll be able to sustain the programs we have whether or not the there's fluctuations yes so um let me ask the the notation you have here so all the MHSA carryover fund is required to be added to year one which is what you have on um on this column all three years the first I'm reading the first sentence of the uh FY20 the MHSA funds and we uh are spreading it over three years to cover the gap between the budget versus the revenue amount so is it a state requirement that we spread it out over three years?

Yes it's both so the state requires that you plug it in to a certain place then they created formats and formulas that allows you to extrapolate and then we can commit our desired amount to the years and I'll let uh Tracy speak more overall the requirement is that we have to have a balanced budget for the three years and so based on our current budget and what we want to budget next year for 26-27 in order to maintain that budget based on what we expect the revenue to be over the next then two years besides next year we have to spread that revenue across the the carryover across three years um you can see in the FSP component we're not using any money in year three that's because we think our 35% allocation of BHSA dollars by year three for the FSP component we won't need any carryover in that in that area but because our BHSS our discretionary component there is such a gap between revenue and our state allocation that's where we are continuing to use our carryover all three years in order to have a balanced budget that we submit to the state now next year when we do our annual update uh based on again new projections from the state as well as our own revenue projections here with our Medi-Cal billing uh you know that number could slightly change but the it is a requirement that you put all of your carryover into in these in these tables into next year and to year one and then an other tabs in the budget you spread it across the three years as required okay so I appreciate that nomenclature because you you have zero in year three under the full service partnership even though it is over three years correct so I mean this is something I I would like you to think about you don't have to answer it right this minute until after we go through one B because looking up ahead in terms of the bridging between the MHSA to the BHSA transition uh the nine million dollars that you have there for the behavioral health services and support um in year three can we do the same thing and use that to meet the gap that we're finding even after you exhausted all of your other funding sources and we included measure W in terms of bridging MHSA to BHSA.

So may I repeat back your question so if there was a way to cover the entire Delta for example in this fiscal year could we push out our carryover to the other two years?

Yes.

Okay.

Now in terms of our planned submission it will look very different.

And I say yes with my whole heart and throat but the state will have to you know approve that process so okay thanks.

Okay yeah so supervisor Tam asks some of my questions for real quickly so um this last question she just asked if you had to revise your plan when would you have to get that in to the state the state has asked this week for us to re-revise based on the errors they corrected if we revise anything else we'll have to just submit and go through the process again so that could happen at any time.

Any time okay okay so I appreciate the um the background leading up to where we are today kind of the historical uh background um tracing the fact that um we were doing more uh upstream and now we're doing more downstream and it's directed more at housing as well um and refresh my memory problem was that a voter initiative or yes it was the state state put it on the ballot uh it the governor um lobbied for it but it was placed on the ballot yes by the legislature by the legislature so it wasn't a voter initiative it was uh it was a voter initiative but it wasn't a voter initiated but it it appeared on our yes and there was and they they didn't understand all this when they did it who who is the they I want to the folks in Sacramento uh I don't want to speak for them what I can say to speak for them when I when I personally have spoken to many of the legislatures they did not see the fine print and so some of them weren't aware of the impact it would be uh and some um yeah so that I think that's all I'll say because it's just baffling why they would consider obviously I know what I was saying all along is it's not either or it's both we need the prevention but we also need the housing so don't rob Peter to pay to pay Paul in it I mean I I just it's you just cause me so much trauma having to revisit that.

Thank you anyway Vanessa that's why it's the question.

I couldn't recall if this came out of the legislature or if it came from a voter initiated it was not a voter initiative.

Correct and that's again why we uh we are an somewhat of an anomaly statewide again many not many some counties will had to rebuild or create i e a housing system or had to rebuild or create an FSP system.

Alamina County had already done that.

Ours again is impacted differently, but yes.

Okay.

And I have questions on certain slides, but I'm gonna try to hit stuff real quickly.

So what I'm trying to understand is with the housing piece.

What is the operational coordination between your department in H and H.

I will obviously have to defer to Ms.

Chowder for some, but what I can say is about $30 million in programming and staffing and other areas, all of the housing for the most part, a very few amount is administered through H.

So the way that it works is we receive the funding and then they administer the services and it goes through coordinated entry.

In this IP, based on the new definition of housing, we were though able to fund uh pure respite, other programs that meet the high housing criteria.

Those are still within the system of care countywide, and so can and are still going to be administered.

So the prior year is around 30, 27 to 30 million plus all of the other subsidies we provide H H.

So I'll defer to her.

Yeah, uh Supervisor, just to kind of build on that, um, that again, because of the way that our uh MHSA programs were structured, we're one of the counties that was already investing heavily in housing.

And so uh to meet that uh threshold of the 30% or 35% for housing, um, a lot of what Dr.

Tribble just described is already uh in that bucket.

Um if we were to back things out of that bucket, oh thank you, Anika Chowdry, agency director for Alameda County Health.

Um, if we were to back out uh things from the housing bucket, we wouldn't necessarily have enough other services from the system that would actually qualify to fit that bucket because those services are all for people with serious mental illness and intended specifically for the county behavioral health system.

Um so I think in net uh we were only added about five million dollars to the housing pool uh through BHSA compared to you know what the investments were previously.

Tracy hasn't yet.

So I would say under BHSA, a simplified answer is that uh I would say about two-thirds of the funding is administered through H.

And then about a third will be overseen by behavioral health, and that includes we are funding under the housing intervention component.

What I would say would are not necessarily new services, but they qualify under the housing intervention component.

So that includes, like Dr.

Tribble said, our peer respite program, two adult residential facilities, or they're called ARFs, um, also two SUD recovery residences, and then four of our intensive outreach programs are also funded under there, as well as everything that we had currently funded under MHSA, which includes our board and care uh program, all of our rental subsidies, our operating subsidies, all of our shelter programs, all four directed to individuals with severe mental illness.

Okay, and so that's gonna come out of that behavior health bucket.

Yes, yes, um, but will the housing bucket?

Yeah, the housing bucket, but will that be administered by H the two-thirds, it's gonna be administered by H and H not by U folks.

Correct, and that has been the case uh with the creation of H H when our housing division moved to agencies, it's not administered by our department.

Okay, all right.

Well, I just think it's important that there's um this collaboration uh as um as uh sufficient as possible.

So we're maximizing our abilities to uh serve uh the public interest.

And then the same question is with the Center for Healthy Schools and Neighborhoods, and also the Alameda uh County Office of Education, because a lot of some of this, the new plan is focused on youth.

So I need to understand what's the level of coordination there.

Absolutely.

100% of those prevention services that you mentioned, all of those are administered through uh AC Health, the Office of Schools and Coordination.

And in terms of the coordination that happens, so as a managed care plan, we're still responsible through our child and young adult system of care to for the system.

So there is I believe Director Charlie can speak to what they do.

But there is still a requirement that we have to interface with all of the schools.

So we do fund all the providers, EPSET, all of the services that occur, but for those portions, that's 100% through agency.

So in that space supervisor, I can share a little bit more in the next space, as Dr.

Tribble said, some of the funding that was going through the Center for Healthy Schools and Communities was for prevention programs that were intended to do coordination at the school level.

So in terms of figuring out how to uh bridge those programs, we have worked with uh the center to absorb some of those um uh reductions in our MOE and then absorb some of them with the next bridge process.

Um the center also works really closely with the Office of Education, and so they're working together on partnerships to figure out how to encourage providers to be able to tap into the statewide children and behavioral health youth initiative, uh, which provides mild to moderate services in schools.

Um the specialty mental health services would continue to be provided by behavioral health, and so that back end coordination will continue to happen.

But that's one of the um the primary things that we want to look at over the next year, is to make sure that um you know providers have other billing options.

And so that leads me back over here.

So Dr.

Tribble, uh you mentioned on one of the slides how with Medi-Cal and HR1, uh and Prop One, we want to get folks billing Medi-Cal.

Okay, but we also are going to provide some bridge for those who either aren't um haven't been billing MediCal and need to understand that uh did I hear that correctly?

Yes, and I the only correction I would say is uh it's the state desire for uh providers to bill more Medi-Cal.

Right, and so yes, and this first year, anyone who transitioned uh to or the early intervention under BHSA, we are prepared to ensure that there is no loss for them.

So, whatever their contract amount, we'll make sure we match that with BHSA dollars.

Okay, and do we have a figure on what we think that might be?

Anywhere between 12, I believe it was on some of the slides.

We anticipate it to be.

Okay, and you've got and you've considered that when we get to the bridge.

I believe that is included in the solutions that behavior health already accounted for before the bridge, okay.

Um I would say because if it isn't, I need to make sure it is.

Well, all I can say is that right.

The 10 to 12 million dollars is not for measure W, that is part of the carryover amount.

So that is part of the our integrated plan, correct, through BHSA.

Okay.

All right, let's see here.

And then that was an interesting question that I had as well.

So when they talk about early intervention programs, it's not all the prevention programs that you listed at some point.

So what do they consider to be early intervention?

Great question.

I will only comment on one because it's been the subject of many different uh community questions and stakeholders.

Um, first episode psychosis is one, and most counties have used that for their youth or early intervention, and uh with some uh success.

Evidence base does allow us to have older, we use it on older the state is encouraging counties to use it for the lifetime, so expecting i.e.

that a 60 or 80 year old could have their first urbisoid, but that is one type of prevention, and so I'll defer to uh state uh Tracy to talk about uh the other types of early intervention programs.

And real quickly, uh Tracy, when the state says early intervention, because it was described earlier with MSH uh the mental health services we were doing upstream, and now with uh behavior health um uh services act, we're doing downstream.

So is this early intervention?

Is it upstream or is it downstream?

First time you get an a diagnosis essentially.

So you either have a diagnosis or you're likely to get one.

Uh so it's it's it's it's at the very end, it literally is downstream, and you're already now becoming part of the system.

Okay.

So it's you're not severely mentally ill, but you clearly quote have a mental illness, a diagnosis.

I see.

And if you did not have one, we presume you will, because there will be an assessment, and then you will have one, and so then you'll be part of the broader system.

Okay.

Do you have anything to add?

Thank you, Dr.

Thank you, Dr.

Shavel.

Um, I think I think you said it all.

It's really to prevent individuals from having a from their mental illness or mental disorder becoming severe and disabling.

So it's really, I would say at the beginning of our treatment continuum, um, we are allowing the outreach portion as well as access and linkage.

So that could be um helping individuals um find services that they need.

It might not be a treatment service that they need.

Uh, and then if they do need mental health treatment services, um, then they can move into treatment within early intervention.

Um, it's considered brief treatment.

Um, and it's a time-limited service as compared to ongoing um treatment services.

And I would say um that yes, that access and linkage piece is a core piece.

As you saw, it's one of the key needs in the community, more help around access and coordination.

So also these programs are um going to have a um part of their service modality is around helping people find what they need.

It could be treatment services or or substance use services, or it could be something else.

Um, you know, helping their child get into school or get into another type of program.

If their child, you know, there's disharmony in the home and they need help with tutoring services for their child, for example, like they won't need treatment services, but they will need something else, and they will be able to this the system will be able to help triage that in in that middle piece of access and linkage.

So it will also focus quite a bit on um childhood trauma.

So that's one of the populations.

Um, I would say under BHSA, it is um early intervention is really for targeted um populations, one of them being um children who have experienced trauma or have been in the juvenile justice system or um in um the uh social welfare system.

So, yeah.

Okay, then a couple other quick questions then on the go to go to the audience.

So um the Delta, one of your slides, it's still 23 million.

The if you're referring to the fiscal impact as of March 2026, we are still operating from a Delta, yes, and that is uh, but our in our strategy to at least pay for the services that are in the plan are to use the carryover.

So yes, we are still operating, we have the plan to plug it in that way in terms of the services that were eliminated without coverage.

Yes, it is approximately 23 million dollars.

Okay, that's what I just want to make sure I keep in my mind, because as I said, it's a lot of information given covered here.

Yes, and if you look at slide 24, we get the got the update now.

Now it's up to 25, but it's it's all the same.

For us, it's a large number.

So and then uh earlier on the 120 uh thousand um millionaires, that's statewide, right?

Okay.

Not in Alameda County.

That's okay.

And once again, if Supervisor Tam and I approve moving this plan to the board, and it needs to be in the board approves and it needs to be modified, you can modify it at any time.

That's correct.

It will allow us to meet the legislative guidelines from Prop One.

Okay.

All right.

So let's um, I know the uh PAL committee and the joint committee were canceled today, so we have a little bit more time.

So let me have speakers just on this item.

Uh, because I really want to make sure we're all on the same page when it comes to this item.

So, I just want speakers on item one a.

I was gonna take speakers on everything at once, but I'll just do one A only.

So if you want to speak on one A, I'm gonna give you two minutes on item one A.

So call the speakers and just on item one A.

Not the bridge, but one A.

Go ahead.

Jennifer Johal, you put number one, but if you're speaking on one A, please come to the podium.

Okay.

Uh Chris Cara, Alfredo Alvarado, Monica Zaniga, and Daisy Vargas, first three.

Thank you.

So this is Chris Cara with Filipino Advocates for Justice.

Um, I'm here part of the prevention matters collaborative who serve underserved and ethnic language populations.

UELP.

Uh, we ask that you prioritize UELP mental health prevention programs for immigrant refugee and indigenous communities that will be cut by Prop One.

Uh for us Filipinos are a uh very large community in central and south county, yet among the populations that are underserved and underutilized services.

Um, our community is one where prevention is most responsive and are made more vulnerable to being destabilized by housing and immigration policies on top of impacts of uh Prop One and HR1.

We are among the providers whose programs will be shut down due to cuts in prevention, which is an approach we have found our community responds best to.

And um, to speak on the last point, beginning with a diagnostic approach, which is the EI approach without outreach education and stigma reduction, um, does not align with uh the needs of uh underserved communities.

Uh we are very appreciative of the leadership of the behavioral health uh or the Board of Supervisors Health Committee and the board's consideration of prevention programs and measure W essential services.

However, what was earmarked does fall short of keeping UELP programs whole, and even the state totally removes that population focus, which is uh where UELP providers are really good at filling the need.

We ask that other funding sources such as reserves and other uh unspent funds be used to keep UELP prevention programs whole.

Thank you.

I just want to emphasize to the speakers, please just speak on the three-year integrated plan.

We're gonna talk about the bridge, the next item.

So if you're talking about the bridge, please wait to talk about the bridge when we take up the bridge.

So go.

Uh good morning, members of the board and everyone present.

Uh, my name is Alfredo Prado.

I'm a health educator for cultura y viene star program, um, a program for which uh more than a decade has provided prevention and yield intervention services uh to families in Livermore, Union City, Hayward, Union City, uh in other cities throughout Alameda County.

Uh today uh we ask you to consider allocating all or as much as possible of the $15.2 million intended to mitigate the effects of the transition to proposition one in the BHSA towards supporting mental health prevention in yield intervention programs such as Cultura y Bienestata.

These programs are essential because they provide support in our communities' language with cultural sensitivity and within the neighborhoods where our families leave.

When people receive uh help early through guidance, support, and access to resources before reaching the crisis, we not only protect the mental health, but we also strengthen the entire community.

Prevention and yield intervention are not expenses.

They are smart investments.

Every dollar invested today help reduce the human and financial cost of much more expensive treatments in advanced stages, hospitalization, homelessness, and family crisis.

We ask you to invest in the future of our communities, in the dignity of our families, and in a more humane and sustainable uh healthcare system.

Supporting prevention and yield intervention programs means supporting the lives, hope, and well-being of everyone.

Thank you very much.

Once again, I think speakers are still speaking about prevention.

So, I'm the same for me.

I think it might be better.

Yeah, I think we might speak on the next item.

Yeah, I think you'd better speak on the next item.

So I'm gonna hear also thank you.

Okay, so anybody else have any questions?

Comments, clarification on item one B.

I have speakers online, as well.

Um, I'll start with John Lindsay Poland online.

Uh thank you.

Um we appreciate that.

Um BHSA imposes restrictions on how money is spent, but what's supported and what's cut in the integrated plan should be based on how much programs actually cost, as well as how much revenue will be available to them.

What's entirely missing in the presentation is the actual spending of MHSA funds.

Actual spending of MHSA funds has not been more than 75% of the MHSA budget during the last six years.

You'd think that what is being called the budget would be based on such actual spending.

And because the state typically receives more MHSA revenues than it projected, typically 30% more, the actual amount of BHSA revenues for Alameda County is likely to be more than the state projects today, as Dr.

Cherbo mentioned.

If the county spends only 75% of its 164 million dollar budget for BHSA for the coming year, and it gets projected revenues of 124 million, it would not have to use carryover at all.

To really know what programs and how much must be cut because of Prop 1, we should know how much the county has actually spent and on what buckets, not what was budgeted, which is never realistic.

Planning should also account for projections of BHSA revenues that could change.

So the question I hope supervisors will ask is what would the expense budget be if it were based on what has actually been spent in the past if there were not cuts in programs, in addition to whatever additional spending requirements Prop One adds.

And that's not really in the presentation.

Finally, it would help if ACBH publishes the detailed data on its projected spending on housing of all kinds from BHSA Measure W that Supervisor Miley was just asking about.

It doesn't get to that detail in the presentation.

That would be very helpful as we look at the other sources for housing.

Uh good morning, uh Chair Miley and Supervisor Tam.

Um I'm Ana Opadaka with First Five Alameda County.

Um speaking today on behalf of First Five, um, we appreciate the county's work on the Alameda County Behavioral Health Services Act, a draft integrated plan.

We want to acknowledge the significant work that went into the plan, particularly the commitment of Alameda County Behavioral Health to community-driven planning, cross-sector engagement, and advancing equity.

We also appreciate the clear identification of children and youth, including children ages 0 to 5 as a priority population and a thoughtful synthesis of community input reflected in the categorized areas of community need.

As mentioned in the presentation today, we recognize that BHSA introduces new structures and constraints and that counties are navigating a complex transition.

Within that content, we believe there's still flexibility to meaningfully incorporate early childhood focused approaches in the plan in a more significant way.

And we offer these following recommendations.

One, more explicitly incorporate ages zero to five into BHSA strategies.

Two, leverage early childhood systems as access points, three, align existing local investments like Measure C and Oakland Children's Initiatives.

Four, include evidence-based early childhood approaches and five, strengthening cross-system coordination.

Given first five Alameda County's role as a local early childhood systems leader and funder, there is strong value ensuring that early childhood expertise is consistently represented in BHSA planning, implementation, and evaluation process.

This could include participation in implementation planning bodies and advisory structures, cross-systems coordination efforts, and strategy development related to children and youth investments.

We see this as an opportunity to build on existing collaboration, ensure alignment across county systems serving young children and families, and we would welcome the opportunity to partner with Alameda County Behavioral Health to further refine early childhood strategies, considered ways to better align funding and implementation approaches and ultimately ensure that young children and families are fully reflected in the work of both of our agencies.

We appreciate uh Alameda County Behavioral Health's leadership in developing a plan and the strong foundation it provides.

We look forward to continued partnership in advancing behavioral health systems that is comprehensive, equitable, and responsive across the lifespan.

Thank you for your consideration.

EBRHA.

Good morning, Supervisor Miley and Tam.

Derek Barnes with uh Ebra and a member serving Home Rise and Home Bridge Board of Directors.

I wanted to commend uh Dr.

Tribble and the AC Health for the depth and transparency of the plan, the shift towards severity-based care, housing intervention, and full service partnership expansion is the right direction.

And the bridge framework is uh a responsible attempt to manage an extraordinary difficult transition.

Supervisor Miley, you're right.

A lack of state legislative impact is baffling on top of other fiscal realities that are also uh needing your attention.

But first, I don't think I saw how the 10.7 million dollar gap would be resolved.

Uh, the risk to key contractor providers beginning July 1st.

The board should require a specific resolution before that approval.

Uh next, it looks like the MH carryover drops from 45 million in the in year one to 9 million in year three.

And every provider uh bridge today faces the same cliff in FY27-28, unless alternative funding pathways are identified now.

Uh, all front plans uh due in December are only meaningful if the county has somewhere or has options to direct the providers when the bridge ends.

And uh finally, um the property owner outreach and mitigation fund targets about 175 units annually, but doesn't name a procurement mechanism uh an administrator in any timeline.

Um that's about 92 million in housing uh intervention funding that depends on willing property owners, but it's unclear if the plan to engage them is based on stakeholder engagement and comments that I saw reported.

Uh thank you so much.

Last online speaker, Sarah Kim.

Hi.

Good afternoon.

My name is Sarah Kemp.

I am a clinical supervisor at Crisis Support Services of Alameda County.

I'm speaking today on behalf of our post-hospitalization and follow-up services and support groups for survivors of suicide attempts.

Both programs are evidence-based and unique intervention serving the highest risk population in the county.

People who've already made an attempt to end their lives.

The clinical data is clear.

The risk of suicide in the 30 days following a psychiatric discharge is over a hundred times higher than the general population.

These individuals are often turned away by other providers because the risk is just too high.

Bridge funding is key to giving our program a chance to secure alternate funding for these important programs.

Without bridge funding, both programs will be ending next month.

Thank you.

In person speakers, they're still in-person speakers.

All right.

Once again, the item 1A.

That's all we're covering at the moment.

We haven't talked about bridge funding.

We will get to that.

So if speakers could just speak to the integrated three-year plan.

Call the speakers.

Alison Monroe.

And Heather Little.

No.

Oh, okay.

Um, I'm Alison Monroe.

I'm with FASME, relatives of people with serious mental illness.

My friends heard that some programs were going to be cut, and they asked me to look at the integrated plan and try to figure out which ones and how much.

It was very difficult to find that out from the plan.

By comparing it with earlier plans, it seems to say that funds will be cut for many programs we're interested in, including the Family Education and Resource Center, several of the wellness centers, Bev Bergman's family advice station at John George, the Mental Health Association for Chinese Communities, two chapters of NAMI that got little subsidies, which are missing from the integrated plan.

And supportive community housing land trust, which buys up land for board and cares.

Are going to be cut.

And we are also sad that anything that provides board and cares might be cut.

The plan is not very clear about what's going to be cut, why and when.

If I had the power, I would delay approving the plan until these concerns are spelled out.

My group supported proposition one when it came out.

We have a little bit different perspective than some people.

Full service partnerships, permanent supportive housing and prevention are great, but to us, licensed housing.

Let's board and cares early intervention.

That means early recognition and treatment of psychosis, and specific one-on-one communication with family members of the seriously mentally ill are more important because they recognize the needs of people who have a serious illness and don't know the real.

Thank you.

Good morning.

My name is Heather Little.

I'm the COO for Alameda Family Services, and I'm also a former First Five Association Systems Director.

So I know firsthand what early intervention and prevention I feel like I really understand that.

And I think you do too.

I think we are from a county that has prided itself on building out this system that has been supported through those MHSA funds.

And I really wanted to just respond to a you know the revised definition of what early intervention and prevention is now going to potentially be seen.

And to me, early intervention and prevention is keeping people even from getting anywhere near the system.

That is what we're trying to do.

And to hear that the new revised definition being kind of funneled through the BHSA lens of early intervention is now you're just in the system with your initial diagnosis, and we're trying to keep people from getting to, you know, severe specialty mental health services is not the definition.

We want to keep people out.

And I think we've done a really phenomenal job of doing that thus far.

And we've known that this is coming.

We've known that this is going to be the potential implication.

We've known, like, exactly the question that you were asking.

What were they thinking?

And we knew what many people wouldn't knew what they were thinking, but they sold a smoke in mirrors because it's very easy to look at people living on the street and saying that this is the problem, but you can't separate that from early intervention or prevention either.

And I really want to applaud you, Supervisor Tam for asking those key questions.

How are we gonna have a system where you're taking away from one and we're still required to do this?

We're still have to address the situation without having a full complete plan that's going to point the direction of how to do that.

So thank you very much for asking the hard questions.

Thank you.

I received another comment from Tony Panetta.

Hello, Tony Panetta, Alameda Health Consortium.

Thank you, Supervisors Tam.

Thank you, Supervisor Miley, for this conversation today.

Thank you to our ACBH colleagues.

Um, we appreciate you saw a summary of the work.

Um, we appreciate the work that has gone into developing the BHSA integrated plan, and we understand that the state requirements are round round peg square whole problem.

And I want to lift up the testimony that we just heard about early intervention and prevention being part of the continuum to prevent strain on the specialty, excuse me, the specialty mental health system.

One of the unique aspects with the federally qualified health centers is that we had the flexibility in a multi-decade partnership with ACBH to really shore up our integrated behavioral health system to do just that, and the state infrastructure is really being or is really driving um crumbling of that infrastructure.

You do know that in federally qualified health centers, we don't have the same capacity to use community health workers for health education and stigma reduction because those types of positions are not compensated in federally qualified health centers because the complexity of our billing.

So we are concerned about even in the federally qualified health centers, the reduction of the early intervention and preventive services that we typically will convey.

We also are concerned that you all are very aware, our entire county is aware about the projected loss of insurance coverage, both in Medi-Cal and people who come off of Cutford California, driving an increase in uncompensated care.

Unfortunately, the state plan requirements do not allow for the county to indicate that in the BHSA integrated plan.

So we are looking forward to working in partnership with AC Health and the County to try to figure out how to be creative, but we are also concerned with this infrastructure.

Thank you.

Thank you, Elaine Perry.

Also, it's a bit confusing on your cards which items you are speaking on.

So if you're also speaking on this item, please go ahead and stand up in line at the podium.

Hi, good morning, uh supervisors.

So thank you so much.

I know he's well how we're and thank you.

You have a little behavior how, yeah, I think he's very, very uh challenge time from the state to the county.

I know he's a lot of work.

Um, yeah, but I want to mention what our proposal is for saving the the life, right?

Saving the the who had the mental health challenging now community.

So when they say about the early prevention of intervention, so totally let us confusing.

Yeah.

So I want to um let the people of the behavior how to well close correctly with the stay to let our goal is keep the same.

So um I I as our mental health association or for Chinese communities, we our work not just early prevention.

We save the lie on the street.

Save the light.

They have the very challenge for the suicide, something like that.

So you said that's the early prevention is not fair.

So I just want to save the people's life in our community.

And I also had the well beautiful carry the um how not should we have the um uh the other uh the well in this area.

So I don't want that it's just standard light.

Is early prevention or not early prevention?

We must the same goal is to save the life who has manhood challenge of their life.

Thank you so much for your hot work.

Thank you.

So I forget to introduce myself.

My name is Ilin Penn.

I'm the I said that I returned founder and the mental health association for Chinese communities.

Thank you.

Thank you.

I believe that is the last speaker.

All right, thank you.

So if I can have the um Dr.

Tribble and her team uh respond to some of the comments that were made, uh, you know, John Lindsay Poland about the actual expenditures.

I think that's also something that Ryan Bloom has raised to um from the behavior health advisory uh board, uh the whole actual expenditures and the calculations and why not use that, and then um everything around early um intervention, uh it's defined one way by the state, but um we have can we have any flexibility around that or any alteration of that?

The whole listing of how the housing expenditures are gonna break down under the housing bucket.

Um let me see here the um first five uh recommendations that we heard as well, and I think those are some of the things I picked up for my notes.

I don't know if Supervisor Jam has other uh items.

You got them all, the ones that I flagged.

Yes, I will take a few of those in no particular order.

I want to affirm what what you heard uh that the state's definition is the way that you heard the uh public comment, it is moving it toward people having more access.

And we do also believe it has been successful here in Alameda County to prevent them even coming into the system primary prevention as well as population-based.

Um, and we don't have flexibility in terms of that.

The state does look actually at how the program is uh structured, it looks at the types of services, and now with the votar and the data and the elements in order to meet those requirements, the programs would have to shift.

So those prevention providers or early intervention providers, they actually are going to have to do programmatic adjustments.

So under Prop One funds, we have you know flexibility, non-prop one funds, the county can do other things.

Yes.

Um, in terms of the housing breakdown, um, I certainly will defer to Director Chaudry.

Um, the ones that you heard Stacy uh Tracy, I'm sorry, Tracy go through those are actually uh a line by line breakdown, and although it's a and it occurs in different parts of the new plan template, uh, those are the ones that are through our behavior health peer respite, etc.

Those ones she mentioned there.

So I'll defer to um Dr.

Charlie to speak to that.

And then the one other thing which I think will be very important, that was um Mr.

Lindsay Poland's conversation.

Uh we've actually not had a surplus in and dollars received from the state.

Tracy has those dollars.

Um my glasses won't work that way, so you can feel free to just for your sure.

Um, so we do track.

I brought my computer.

Um, we do track um on a yearly basis.

So the state gives us a projection of what a revenue is going to be.

So we track um at the end of the year.

Well, did we actually receive more or less revenue from the state?

And so I can highlight um for you all.

So last year, yes.

Oh, please.

Uh for 24-25, yes, we did receive 4 million more than we expected.

However, in 2324, we received 35 million less.

And also in 2223, we received 35 30 million less.

In 2122, we received 6 million more.

So it goes up and down like that, but we've had two very significant back-to-back years of significant amount of less revenue than we thought.

And as of right now, we are expected our estimate for this year is 131 million.

We actually to date have only received 60 million, and we have four months left to go.

And based on the averages from the other years in these four months, I don't think we're going to hit 131.

So, and then we hopefully, again, that is the revenue.

Hopefully, we don't spend all of our budget so that this doesn't become an issue.

But when we do have these um uh unexpected under amounts of our allocation, this is where our carryover also comes in.

Um, so I I wanted to highlight that piece.

And then something else, this is why I put up the slide, Dr.

Tribble showed you of our new BHSA website.

We do realize that with the new integrated plan, it leaves a lot of information out and a lot of details.

So we will be putting up as we develop the website, we will be putting up details on what BHSA is spending, uh what we are spending the dollars on.

So we will put up the details on all of the housing uh projects that we are spending on, um, full information on the full service partnerships, and then as well as a little more detail on the behavioral health services and supports programming, uh, because we do believe in that transparency has been lost with this integrated plan, and we want to make sure that the community has that information.

Thank you.

And the one piece that I will add, if I may, um just to underscore uh specifically how that relates to providers, our use of carryover, that's essentially how we ensure they make payroll.

So we will use the carryover even in the 30 um and then 20 million dollars short years, we will continue to pay them using our carryover.

So they have not seen that disruption um as much, uh, but we've have been absorbing it for the last uh three years.

Um I appreciate that.

I have one other question along those lines.

So the 14% uh prudent reserve is on top of the carryover that you maintain.

In the times of volatility that you mentioned where you're short like 31 million one year or you're slightly over.

Do you have you ever used the prudent reserve?

So what is it there for?

I'll say one thing.

No, please.

Uh we've not been able to attain the level of economic downturn statewide to qualify for use of a prudency.

They don't consider volatile revenues as a way to access.

So that's been a challenge for counties.

And again, that is what is also preempted counties from making sure they have revenues to sustain.

So technically it's more if there's a depression, if there is literally a huge, something like we experienced in uh 2006-8-ish.

That is the the catastrophic level of downturn that really defines how counties can use prudent reserves.

So we've not touched it at all since then.

Well, I'm sorry, what is the criteria of reuse uh dictated by the state?

It is a serious economic downturn, and really the um the role of it is to support the full service partnership funding.

So if there was an economic downturn to the point where we couldn't support the maintenance of effort of our full service partnerships, that is the priority of what the funding is supposed to go towards.

And then under MHSA, um there has been regulatory restrictions where we have not been able to also access it because we have always used MHSA dollars to fund a workforce component.

And in the years that if you asked the state to use your prudent reserve, you couldn't put any money into workforce.

And so that was always a bind for us.

If there was actually a need for us, we then would not be able to fund workforce in that year because we wouldn't be able to transfer dollars from one component to another to be able to fund workforce if we asked to use the prudent reserve.

And so what that means is in those early years, years, as I mentioned, when this nationwide we were going through some severe issues, we would have had to cut providers to sustain the system, which seemed um illogical.

So we opted again to use our carryover to still sustain them.

What if it's a government created downturn like HR1 or what happened with well?

Well, what out what else that would be we would love that.

But what I would say is we saw the impact of the federal legislation in those numbers that Tracy just quoted.

So for example, uh, although the current administration is in now, they were in during those years where we saw this striking decline.

It was due in parcel to the millionaires contributed less to Prop one.

They were using and taking advantage of the ways to preserve their funds.

That were some of the issues.

Spending also was was down.

The other piece is that the bump we got, which was I think you said four million dollars.

Um yes, four million dollars one year was uh we saw a slight increase in the number of millionaires contributing.

So it it right now at the national level, there isn't a mechanism for state uh for federal taxes to actually uh stabilize.

So the state's perception is it's beyond their control, they only utilize what they receive uh receipts, and that's what then forms the basis for the assets of the counties.

So we asked the same question.

Um I think the state is looking at their budget, how they will do essential services, and is expecting local counties to do the same.

I will say we have not, we haven't we haven't added any money to the prudent reserve.

We have kept it at 14.5 for quite a while, and any uh interest that's earned on the prudent reserve goes back into services.

We put it back into the treatment component.

And I think the last question is first five.

Um on early intervention, first five a week collaborating with first five on some of their thoughts and recommendations.

So first five did participate in our community planning process as well as um uh we held an a listening session with them, and then we do have dedicated staff within our children's and youth system, um, particularly around early early childhood.

So there is collaboration there, and actually we are funding under the 18 new programs that are um going to be doing early intervention work.

There is a zero-to-five program with a better way.

So and so we will also continue to partner when we start planning again in the fall, um, first five is on on our list to contact as a planning partner.

All right, thank you.

Supervisor Cam, if we heard enough, are we comfortable advancing the HSA three-year integrated plan to the full board?

I want to hear from our side.

Sorry, supervisor.

Um, I think you had one other question uh related to uh specifics around how the housing money is being spent, and we do have Jonathan Russell online.

Um, if you'd like him to walk through what's in that component.

What I'd like is that to be itemized so we can see it in writing.

Sure, we can follow up with that.

Yeah, because I think Avery will say they're gonna be putting it up on their website at some point as well.

I'd like, yeah, we I think for our benefit and the benefit of the public, we'd like to see all that in writing.

So either when this comes to the full board or or um, because I'm hoping we can get to the full board next week.

If that if that's not if that's gonna be too soon, let me know.

Um I think do you mean for further discussion at the work session?

No, I'm gonna try to get this if we get a motion, I'm gonna try to get this to the full board next week for action.

For the full board, um, we normally would do that through a board letter at a um a work session.

I'm sorry, at a regular board meeting.

Um, but I understand that there's some budget updates that are happening, and uh we haven't put a I know the board letter is in draft somewhere.

So I I'm just saying I don't think it's ready for next week, but I could be wrong.

And if it doesn't come next week, now we're just talking about the integrated plan.

When will it come?

It needs to be it needs to be approved before June 30th by your board.

So June 2nd.

A meeting in June, yes.

May I clarify your questions?

Are you looking for clarification?

Because uh I think that could be available on what currently is funded uh through MHSA within our an itemized list of that uh with our H and H programs.

I think that that exists now prior to the plan.

So um we can extrapolate the detailed images say portion is the one that Tracy mentioned.

We certainly can add that.

Um, but I think we we do have some information about the programs.

From H and H, I think.

All right.

Are you done?

Okay, because yeah, let me just see if Suppressed Tim are you are you comfortable?

Because I'm comfortable advancing the uh behavioral health services act three integrated plan to the full board, in addition to making sure we can see an itemized list of the housing associated with uh with the uh plan.

Um I need some clarification before I answer that question.

Okay.

So um when you advance the three-year integrated plan, does that include um the allocations on the carryovers for years one, two, and three uh on the behavioral health services and support.

So I I would want us to look at uh using the nine million dollars in year three to um basically backfill the gap that we will be seeing in the next presentation.

All right.

Well, then if that's the case, why don't we wait until we hit have this next presentation to see if that has any um bearing on your thinking on this?

All right, okay.

So we're gonna hold off on a motion on the integrated plan until after we hear the next presentation.

Okay.

Thank you.

Because it's um based on what surprise you would like to have done.

I want to make sure we have the benefit of the next presentation.

All right, so um item one B is the one year bridge funding plan.

Um we're gonna take a five-minute recess, then we'll take that up five minutes.

Okay, we're gonna be like, yeah.

All right, we're going to reconvene.

Clerk takes roll.

Supervisor Tom, present.

Supervisor Miley.

Present.

Okay.

So thank everybody for their patience.

So let's take up item one B.

Good morning, supervisors or good afternoon.

Anika Chowdhury, I'm the agency director for Alameda County Health.

And I'm here to share a requested update regarding the planned one-year bridge to support MHSA to BHSA transition.

I'll present the slides on behalf of our team, and we do have leaders from across the agency available both here in the room and online to answer any questions.

So before I begin, I do want to again acknowledge the difficulty of this moment and uh and the process and appreciate our community partners for their patience.

And as you know, uh for Alameda County, and as you just heard from the previous presentation, we've had a long history of using MHSA in flexible and expansive ways.

And uh the transition to BHSA is just bringing with it some new rules and funding constraints, which have required the behavioral health department to make some difficult programming decisions toward the end of the last calendar year.

Um over the past few months, we've had, you know, we've heard from the affected providers, received direction from your board to explore bridge funding, and had an opportunity to do some cross-departmental planning in our agency.

And at the same time, you know, we continue to grapple with the impending realities of HR1 and a sizable county budget gap.

So my hope uh is that this presentation can help us provide some assurance to the provider community.

Um, and I also just want to caveat that we don't have it all fully buttoned up just yet, um, and we're moving as quickly as we can with evolving information.

Next slide, please.

Uh so this is how we're envisioning uh a one-year bridge to work.

So the goal uh, and this is based on you know what we've heard from providers, uh, is to provide additional time for the CBO community to responsibly transition and or sustain programs.

Uh the uh bridge would be limited to one year for fiscal year 26-27.

Um, you know, we're really wanting to ensure that there's some sort of process measures to avoid the same funding cliffs in the following fiscal year.

So this would include um engagement, uh, continued engagement with providers and county agencies, um, off-ramp plans required of each bridged program by December 2026.

Um, and again, that is to uh really ensure that you know, should there need to be client transitions or if uh they've found other funding sources or they have to end the program that we're aware of that uh by the end of the year.

Um and then, of course, we'll do ongoing coordination across uh behavioral health, HH, and public health, uh, as well as health pack so that um we're all aligned on next steps in moving forward.

Next slide, please.

So as I mentioned before, um, you know, the work of determining program reductions was difficult, and the work of uh thinking through restoration is also challenging as we try to balance multiple priorities and system uh pressures.

So some key principles that our team is applying to this process include sustaining continuity of care and supporting health equity across the broader system of care.

Uh and in this context, this includes behavioral health, homelessness response, public health, and indigent care.

Uh specific to behavioral health, we do need to ensure adherence to various mandates, regulations, compliance with legal settlements, and network adequacy requirements.

And of course, we're trying to minimize disruption to the safety net and client services.

And where we're using funding sources outside of the behavioral health department, we're needing to align state and local priorities from your board, the public health department, homelessness response system, and indigent care.

And of course, the nexus of each of those areas with behavioral health.

Lastly, it's also critical to keep in mind the broader federal policy impacts and the funding changes that are coming our way because we're wanting to ensure that the county systems of care are sustainable in the long run.

So the cumulative disruption of Prop 1 and HR1 means that we do have to be cautious about what's possible given the uncertainty and pending contraction of the Medical system.

Next slide, please.

So here I'll just go over some of the high-level numbers that you heard in the previous presentation as well.

Our total transition gap, meaning the difference between the 25-26 MHSA budget and the 26-27 BHSA revenues is about 77 million dollars.

The behavioral health department was able to identify about 32 million in solutions and had to issue program reductions for about 52.7 million.

That 52.7 million includes uh cuts to both uh CBL providers as well as uh several county programs.

So with the funding sources we've identified to date.

Um, this includes those next three rows of revenue from other departments within AC Health, uh, your board's previous Measure W allocation to the behavioral health department and the measure W requests that we made in April.

Uh, we're we've been planning to uh for the restoration of about 35 million dollars of the reductions.

We've also identified another 7 million in reductions that were previously one-time allocations or are potentially non-client-facing or have overlap with current or upcoming RFPs that may be in the public health or uh HH system.

So we've not included that in the restoration.

Um then this leaves us a remaining gap of 10.7, uh, which you know we would continue to work with the county administrator and your board.

And that uh, sorry if you could go back just for a second.

That in the top right uh is just a reminder for the last conversation that we had at the April 28th work session where we requested 15.2 million in essential county services fund for Measure W for Prop 1 BHSA transition, as well as another 3 million for the health pack network.

And in the health pack network, that would include some uh funding for Prop One mitigation as well.

Next slide, please.

So you saw a version of this slide in the previous presentation, and we wanted to try to crosswalk it to potential restoration using the 35-ish million available to us right now.

So the the, and I'll just note this isn't an exhaustive list in terms of the restoration, as uh some of the programs might be represented in multiple categories.

Um, so for example, you'll see that some of the line items in the potential restoration column exceed the corresponding number in the reductions column.

And the left column totals the full 52.7, and the right column only shows about 30 million as we're working through our process.

So uh this may also be a reflection of some programs not getting a full restoration as we're going on the back end and making our decision.

So all that to say, this is a work in progress and not quite final, as we need to continue to cross our T's and dot our I's.

Next slide, please.

So, in terms of uh next steps, uh we're continuing to work on the final numbers and uh because there's fiscal pressure on smaller providers in particular, we'd like to bring the bridge proposal to the full board for action at either your May 19th work session or your June 2nd board meeting.

Um and the goal here would be to get a final green light for the bridge funding amount, as well as to seek board approval for any uh approaches that we might need to ensure that we're minimizing disruption and payment or service delivery.

Um after that green light, we would be able to notify providers.

Um and our intent is to have any bridge funding be uh effective as of July 1.

So this may, you know, uh include retroactive uh approvals for contracts in some cases.

Uh so again, I just wanna reiterate again that this is one-time funding uh and uh it is expected to end next June.

Um, and so uh it is our full intent to require off-ramp plans in December, you know, and coordinate and work with the community uh provider community over this next year to understand um how they're planning to use the bridge funding and what they're thinking of uh in the longer term.

Next slide, please.

Uh so with that context in mind, we're requesting uh that the health committee please provide any direction and advance the bridge proposal to the full board for action, which I just wanna clarify for our CBO community is would be outside of the the budget process so that we don't have to wait until the end of um June to have final decisions.

Thank you.

And um I'm sure that both of us will have some questions on this uh proposal because I wanna get it a little bit more concrete than what we have here today, and I do want to advance it on May 19th uh for action.

Uh and I'll request the county administrator and the president of the board to make um to schedule a special board meeting on May 19th just to take this up.

So we don't have to take it up at a work session, we'll take it up at the special board meeting, the bridge funding proposal.

That's why I want to make it very concrete today.

So I have some comments and questions, but I'm gonna start with Supervisor Tam first, particularly in light of uh her earlier comment around the nine million.

Um thank you, Chairmarley.

I I appreciate crystallizing what that gap is.

We've been discussing it, we've been hearing different providers expressing concerns and uh trying to understand that clearly is helpful.

Can you help refresh my memory?

I know we talked about funding for the UELP program in the very beginning uh when we talked about measure W and how that's accommodated with some of the comments that you heard today.

Um, the reason I'm trying to sort through that is because um the mental health care for uh the BIPOC community, including the Chinese American community, um, that's been front and center recently because of you've seen what's been happening in the news with the need, uh especially for immigrant care and support.

Yeah, thank you, supervisor.

Um, I'll start with an overview and then I'll ask the behavioral health team to provide some more additional context on this.

Um as uh I mentioned, you know, uh, and as you heard in the previous uh presentation as well, it especially in the prevention space.

There's just some stuff that BHSA is not going to be able to fund moving forward.

Um so we have been working with the public health department to also see what might be possible there because the prevention will be coming through CDPH in the future, albeit at much small smaller scale, um, and it will be a competitive process.

Um, so we don't have enough details from the state to know you know what things will be viable moving forward.

Um, and I think that at this point we're a little hesitant to talk about specific programs because it's fluid in the back end.

Um, but I'll ask Behavioral Health to talk a little bit about where UALP providers might fit.

Thank you, Supervisor Tam.

Um of the integrated plan that you just saw, 10 million dollars of our 26 million dollar cut to prevention went to UALP.

Um, and so there were two providers that opted out from the prevention to early intervention transition.

So that's about how much our our plan included of those providers.

And so the uh remaining delta if a if a provider could not transition or have different types of services is about six million dollars of pure prevention.

But I believe some of that of as you saw in the other slide, based on our calculation, I think other departments are planning to fund that.

So from behavior health, 11 million.

So that 6 million you talked about, is that uh reflected in the 10.7 million gap.

I want to be careful how I answer that.

Um the approach that we took was to look at the different funding streams that we have.

So for example, there are certain things that uh the public health department and H as well as Office of the Agency Director covered in their um process.

So uh, for example, the the trust clinic uh is uh county funded program, which has been funded by MHSA for quite some time, pays for uh county staff.

Uh we needed to backfill that.

Um the REACH program was also in that overall prevention bucket, and so we we've backfilled that.

Um when it goes to, so we've had to kind of uh look at what the funding source is and how it can support uh the ecosystem in a way that makes sense both for behavioral health as well as the the source department.

Um and then in terms of the uh 15.2, for example, that you saw in the essential services bucket asked uh that was a you know, we asked behavioral health to go through and and and uh uh look at programs there if that's the amount of funding that we have available.

Um so then that kind of gets us back to the process that we're undertaking and the various um nuances and needing to meet mandates, needing to look at network adequacy, needing to look at the the various things, and so sometimes it's not a one-for-one backfill.

Okay, I appreciate that's the case.

Um in terms of timing, I I think the timing you set out makes a lot of sense, and then having that uh more dedicated conversation on May 19th would make sense.

We had actually moved um since I serve on the budget and finance committee for the board, our May 14th meeting to May 19th, 18th, because we weren't going to get the May revise until May 14th.

So will you have enough time after we get the May revise to help um like put the appropriate funding opportunities in the right places?

Yeah, I mean, I think the May revise will certainly be helpful for that broader measure W conversation that we're having because we presented a two-year plan for your board's consideration at the last work session.

Um, in terms of the uh BHSA integrated plan and the bridge plan, um, as you heard uh Dr.

Triple and team mentioned that they will be updating uh based on revised edits from the state.

So uh we would have time next week to be able to come back and share more details on that, as well as uh continue to do some work here on what's possible.

Okay, uh so in terms of that category of what's possible.

Um I would like to have us look at using um that third year carryover to help uh bridge this 10.7 million dollar gap because I think based on what you refreshed in our memories about how we're proportioning the measure W funds between Prop 1 backfill and HR1 backfill, we're focusing on Prop One right away.

Um, but that may not be in sufficient time to get the kind of um support some of the providers need.

So I wanted to see if we can look at that opportunity, and then if we we find that we don't need as much, then we can look at um backfilling the carryovers in some way.

Okay, I we can work with the team on that.

Okay, so let me just say, I'm gonna get I'm gonna come back to that too.

Okay, go ahead.

If the desired use of the uh carryover, that nine million dollars, moving that from um year three to year one, it just couldn't include prevention providers because prevention is now alone no longer allowable expense.

It is possible for other uh shortfalls or reductions that were made, if that makes sense.

So of that nine million dollars, if that's moved to year one, it absolutely can be.

We have to revise our budget and resubmit to the state, it just won't be able to cover UELP specifically, prevention only, just because prevention is not an allowable uh component.

Um, and then for whatever is moved for that year three, then we would just have to show because we have to submit a balanced budget, we'll have to show how we will come up with the additional nine million.

What other source if that makes sense?

So if if that nine million dollar carryover as you're asking is used to pay for other types of services, i.e.

in that 23 million dollar that you mentioned, we can do that in the BHSS category, but not for prevention only because Prop One can't fund that.

Um I I understand how you're shifting and categorizing, but I'm looking at the bigger picture issue of filling a gap.

That's correct.

Um has been identified, and how you fill that gap and backfill it, I will leave it to your expertise to do.

Well, it goes back to your question about what can be done.

So if if measure w in the big picture is looking to support some of these ULP, that's possible.

We just on the back end can't do it with the prop one dollars, but we you know, so um measure w is the only component for the carryover that can fund prevention only.

Yeah, I think okay.

I think if we use that nine million, then we've got to identify a source for them to plug that nine million in for third for um three years down the road.

So I I would suggest we just leave it like it is and we get the funding we need for measure w right now.

And don't you go with their nine million in the third year, but what we need now, let's just get that from measure w.

Well, the reason I'm looking at this is mainly from uh options that the department can look at.

And if if they feel they can meet uh this gap, uh, because you saw at our last board work session that the requests for measure w, including from the senior services coalition, exceeded what was allocated in terms of measure w funding for this year, the 34 million dollars.

So I wanted to give as much opportunity to see if there's ways that the department can look at uh like moving some of these existing funds because if we have an emergency now, we don't need to worry about year three when we're not really sure what's gonna happen in terms of the revenue.

We may end up with more in year three and have a higher carryover.

So that's where I'm at.

Well, I have a suggestion on that.

So I'm gonna I'm gonna come back to that in a minute.

So let me just um say I do appreciate the operational framework that looks good.

Uh with the the 10.7 million, is that the gap that we're talking about, or is it gap 2 million?

So the the gap supervisor is uh anywhere from 10 to 22, right?

Uh so in terms of the because you'll notice here that there is actually 77 minus 32 is 45.

So there's a little bit of uh um uh flex there and also uh again the way that the carryover funds are brought over um those are for the plan and not necessarily the the the bridge right uh so by the math on this slide if you look at uh the seven point the seven million that's the one time or consultants or other systems alignment that we would want to do again for longer term sustainability of of the whole system um that seven million that we've not included in the restoration so potentially that could be included in the gap um but this is also us trying to make some recommendations based on the broader context of all of the the requests that are coming to the board for um for additional funding okay and then with the funds for prop one the 15.2 where where does that fit in?

Are you looking at slide four?

Yeah that little yeah that little box up there yeah so uh where you see in the bigger table it says measure W ECSF request April 2026 um that says 17.7 million so that includes the 15.2 for behavioral health which is the bottom red box in the top right um and it also includes about 2.7 for the health pack network uh who are also but it's specific to the Prop one because they've got multiple um multiple pieces there and it doesn't add up to the full 18.2 because uh some of the health pack mitigation is for other purposes right okay so I just wanted to try to understand where that fit in with the the bigger uh table that you had over here so that answers that question now when you go to the the comparison um the restoration is is short by about 20 million yeah it's it does that 20 million include that 10 point seven million gap or what is that so on slide five um this is again i as i said a work in progress because we're trying to match two different processes together um so here in the revenue reductions uh column what you see is uh roughly the total 52.7 in the restoration uh this is the work that we've been doing over the last you know many months and particularly within the last couple of weeks after we had the measure w conversation is to see where the different things might be restored so right now that only totals 30 million but we're working on 35 it's just that not everything neatly fit into these categories that are identified here so can you put that that uh chart up again it's uh it's it's um it's slide five yeah so you're saying on slide five you're restoring roughly 30 million but ultimately you'll restore 35 million that's what we've been planning for yes so we'll still be short if the the if the gap was 50 two and restoring 35 we're still going to be short 17 17 so where's why aren't we trying to restore the 17 so uh again this is uh something where uh there's seven million that um for example there were uh programs that were listed as not being continued under BHSA that were initially funded as one time, right?

And so uh perhaps with the expectation that those will end.

Um so trying to take those out.

There's also other programs that are not necessarily client-facing, but they do support our you know broader behavioral health community.

Um, but again, this was trying to um uh to to bring your board something that uh also reduces all of the requests that we're gonna be bringing to you with regard to HR one and and other stuff.

So that's us trying to be prudent about uh potentially looking for things that do not get restored.

Okay, so what if the board were to approve uh a maximum of 17 million for Measure W for additional restoration?

Would that help you out?

For preventive uh mental health MHA MHSA defunded programs for the bridge.

So I I know that um thank you for that, and uh yes, that would be helpful.

Um, and do you want us to explore options?

Because I think the other concept has been that um you know we the request of us has been to continue to look for funding within our system.

Um, so we've tap that out as much as we can.

But if there is a world where some of the carryover can be used to uh support some of the gap, then as we were just saying that uh the measure W portions could, of course, support prevention.

Well, BHSA, the MHSA BHSA portion couldn't.

Yeah, because what I'm suggesting is if you think you can come up with restorations of 35 million, and the reduction was 52 million, that leaves 17 million.

So, in your and you're kind of thinking you might even be able to get by with um dealing with some of those reductions because they're one time, et cetera.

Um so you might not need 17, but if we were to give you a ceiling of 17 out of measure w, you would find that be to be helpful for the restoration.

Because it doesn't mean you'll use all 17, but it just gives you that flexibility so that the providers have a sense of assurance.

Yes, okay, all right, yeah.

But don't you know don't be afraid to say no.

I just I also have my uh, you know, supervisor, I wouldn't be yeah, we're worried about I know we're worried about a lot of stuff.

You need to ask supervisor Marley where that 17 is going to come from.

Yeah, so the 17 to get back to Supervisor Tam, because she wanted to take it from that nine million that is in year three, I would suggest we just leave that like it is and take 17 from Measure W.

And if you recall at the work session, I said the 17 could come from the prudent reserve in Measure W, which is 170 million over the next five years total, break that down to five years, that's 34 million per year for five years.

If we look at the prudent reserve, we could take 17 million out of the prudent reserve.

We could backfill the prudent reserve with any additional Measure W monies that comes in that's over and above what's been budgeted uh as a result of you know um the collections through um the sales tax.

So I would just suggest leaving leaving them alone, let them keep that nine million.

Let's take the 17, give her a ceiling up to 17 million of additional measure w monies to deal with the reductions in the mental health service act.

I would uh still prefer to give the department director as much flexibility as possible, including an up to looking at how uh to best use that carryover amount and and how it's uh complaces with measure w because um i can't direct at this point directly to go into reserves.

Well, if but if I understand Dr.

Tribble is saying if we take that nine million, you still need to have nine million to plug in for us to approve the integrated plan for the next five years i mean next three years so we still need to identify a source for that yes but if you looked at the way uh they structured the um three year the transfer for the full service partnership uh in year three it went to zero they they did a two-year carryover my question is why can't you do the same thing for the behavioral health services and support which provides a lot of the prevention programs so can you answer that yeah yes um the budget is higher in those years and if we as I mentioned we could with the exception of it would be prevention that means that we we couldn't provide the bridge as we had intended across the three years for the programs it would just mean there would be at least one year or so we would be short and we would have to make sure that we just had enough to pay for it so yes and we do we would have to identify uh how we're going to pay for the existing budget and the programs because that is what is required uh to have a zero balance budget essentially and we and so again that zero out amount in the carryover is because we didn't need it based on a I understand so I'm trying to see if we can do something similar and you responded that in the affirmative that's possible.

As long as yes as long as we find an alternative source we just won't be able to submit to the state uh with a delta right and and I'm thinking that uh we could look at that with the measure W funding as a potential I'm looking at the the timing of the funding availability at the moment.

Yes and so I think a a different way to say it would be uh the three year plan is due regardless and I think as supervisor Miley said you can make adjustments whatever adjustments we make just has to be able to carry the entire amount through if we move the line items and there is an alternative nine million dollar funding source that's possible we just can't not fund otherwise it would be reissuing other additional cuts or we would have to uh kind of internally quickly figure out what to do but please Tracy.

I understand what you're saying in terms of a potential swap and so uh of funding um in for next year and I think uh Dr.

Tribble will do her best to we can look at that at a high level I think what Drill is also saying I'm bending down um is that is that um when we as she's saying when we submit a balance we need to submit a balanced budget to the state so that also might mean that our year three budget just looks significantly lower in order to um have a balanced budget for in the plan and so I just would like the community to also understand that so they are not very surprised or upset when they're like when they think oh the the budget in year three looks really um significantly lower are there going to be new cuts coming in year three and so should we start worrying about that um and I would say there would be unless we had the revenue to support it we would have to it would just be pushing out additional points yes um and just I just want to reiterate um more because I'm the technical person who has to put the plan together um that if we utilize the nine million um for other types of programming we do have to make sure this this nine million I know it would be going into our discretionary component.

That's where we had been cutting.

So we do have to make sure again, half of that has to go to early intervention, and half of that can be other types of funding or other types of services, treatment, workforce, etc.

And we are currently all uh out of balance right now um in in balance.

So adding the nine million, um, we will definitely have to do some work to ensure that that balance stays in play, which might be difficult in terms of what we can fund and can't fund.

Okay.

Um I'm hoping to leave that up to the department, not just within behavioral health, but the entire department and give uh department director that flexibility in terms of coming back to the board.

I don't want to micromanage exactly how you're going to move different funding sources.

I just want to provide that option.

So what would you like to see on the fifth on the 19th?

Well, if Supervisor TAM is dead set on that nine million, then I would say we have that nine million.

That's gonna go towards the restoration.

But then in addition, we need another uh eight million for measure w for restoration.

And then the agency, because I think she's looking at the whole agency looking at how you can come up with another nine million to deal with year three of the integrated plan.

We can bring some options and and also work with the county of and you would have if if the board takes up the restorations on May 19th based on this, you would have until June 2nd to figure out where you're gonna come up with that other nine million for the integrated plan.

Uh okay.

I think our goal would be to have it as sorted out as possible on the 19th, so that we can't we can go forward with some direction.

Okay, um, but we can we'll let you know if that's not possible.

Right.

So I'm gonna call the speakers a minute, but just want to make sure we're all on the same page.

Um, so the agency is saying you can potentially come up with 35 million in restoration.

That leaves about 17 million short.

The 17 million short could be covered by nine million of year three carryover, and eight million of measure w, and eight million of measure w could come from the prudent reserve, or if the our essential services uh or or we can move it out of the house out of home together.

But the point is we want it to come from measure w.

Then the nine million in the third year for the integrated plan, you're gonna look at how you can cover that through behavioral health and through other agency uh sources, and if you can't cover the whole nine million, you've got to let the board know where you're short.

So if you're short, then maybe my steam colleague would consider additional resources from measure W or someplace because we gotta have that additional money for the third year.

Yeah, understood.

Yeah, okay.

All right.

Uh, and then just keep in mind that the nine million, some of it can go to the integrated plan uh in one category, and some and some of it can't go because it's not allowed.

Yeah, okay.

All right.

So let's call the speakers and see if the speakers have any comments on any of this, and we'll give them two minutes.

Jennifer Johal, Alfredo Alvarado, and Monica Zuniga.

First three, and in person, and then I'll go to online speakers next.

Good afternoon.

I'm Jennifer Johal, and I lead healthcare outreach at crisis support services of Alameda County.

Most don't realize that 45% of those who died by suicide visited a primary care provider within 30 days of their death.

These visits are not mental health visits, but you usually routine checkups.

Therefore, it's imperative that healthcare professionals be able to recognize the signs and symptoms and intervene to support these patients so they don't fall through the cracks.

Our program implements the National Suicide Initiative by training these providers to recognize that risk.

We provide this training for free to remove any barriers to access.

In addition, our team trains other community members, teachers, parents, jail staff, police officers, mental health professionals, and general audiences, so we can help build our community safety net when it comes to suicide prevention.

Prop one's focus on the most severe cases.

Ignores the fact that we can reach people before they ever reach a crisis state, which is additional and unnecessary trauma.

As we wait for statewide suicide prevention dollars to be deployed, we urge you to provide bridge funding to keep our trainings operational.

Thank you.

Good morning, chairs and members of the health committee.

Thank you for your leadership and for recognizing the importance of prevention services within the Meshore W funding.

My name is Monica Suniga.

I work at Tivurcio Vázquez Health Center.

I speak today on behalf of the ULP providers and the immigrants, refugee, and indigenous communities we served.

Today, many families in our community are living with fear, instability, and uncertainty.

When prevention programs disappear, people do not only lose services, they lose trusted spaces, cultural connections, and hope.

Our program is a community-defined evidence-based program recognized at the state level for providing prevention and early intervention mental health services for Latinos community.

However, because we are a federally qualified health center, we have not been able to fully transition into the specialty mental health model.

This place our service at zero risk.

We respectfully ask the county to consider bridge funding for one more year, while prevention state funds are still being developed and released.

This temporary support will help protect trusted prevention services and give programs like ours the opportunity to continue serving families without interruption.

Investing in prevention means choosing healing before crisis and dignity before despair.

Thank you.

Good afternoon, members of the board and everyone present.

My name is Alfredo Alvarado.

I work as a health educator for Cultura Vienna Star Program, a program which for more than a decade has provided prevention and ill intervention services to families in Livermore, Union City Hayward, as well as other cities throughout the Alameda County.

Today I ask you to consider allocating all or as much as possible of the money intended to mitigate the effects of the transition to proposition one and the BHSA towards supporting mental health prevention and ill intervention programs such as Cultura y Bienestar.

These programs are essential because they provide support in our community's language with cultural sensitivity and within the neighborhoods where our families live.

When people receive help early through guidance, support, and access to resources before reaching a crisis, we not all do not only protect the mental health, we strengthen but we strengthen the entire community.

Supporting prevention and new intervention programs means supporting lives, hope, and well-being for everyone.

Thank you so much.

Thank you for your comments online.

Speaker Pisay Finis.

Good afternoon, Board of Supervisors.

My name is PC Finnith, program director of MARU, formerly KCCEB, and representative of the Prevention Matter Collaborative.

Proposition one, redirect mental health fundings to its lock facility and crisis services, specifically prioritizing Medicaid eligible recipient only and diagnostic requirements, and in doing so, systematically defund the prevention programs that immigrants, refugees, and indigenous communities trust and respond to best.

Our UEOP programs are not supplemental services.

They are a safety net beneath the safety net where no one needs to be turned away.

These communities are already absorbing compound shocks.

Federal immigration enforcement has intensified fear and isolation.

HR1 threatens Medicaid eligibility for hundreds of our clients.

Housing instability continue to escalate.

Cutting new ELP prevention programs in this moment will be push will push people towards crisis and emergency rooms and ultimately towards costly LOX facilities Prop 1 funds.

For many of our clients, the new requirements under BHSA are not just ineffective, they are re-traumatizing, evoking histories of immigration detention, forced institutionalizations, and state violence.

You cannot replace decades of culturally rooted, linguistically accessible, traumatized informed community trust with a crisis stabilization units.

We are grateful for the board's recognition of prevention as an essential under Measure W and for the health committee leadership, but what has been earmarked does not keep UELP programs hold.

Partial preservation is not preservation, it is a slower collapse.

We're asking the Board of Supervisors to use the reserve because at this moment it is a rainy day downpour and other unspent fund to fully protect the 7.7 million dollar UELP prevention programs.

These communities did not create the fiscal Prop 1 impose on counties.

They should not bear a deepest consequences.

Do not let the marginalized member of our communities become a fiscal adjustment.

Thank you.

Amy Ladderman.

Hello.

My name is Amy Latterman.

I am the Executive Director of Partnerships for Trauma Recovery.

We are community-based nonprofit provider addressing the mental health impacts of trauma for refugees and asylum seekers since 2016.

Many of our UELP clients have been forcibly displaced and are survivors of torture, putting them at very high risk of intense mental health challenges.

Their newcomer status in our community also puts them at high risk of further victimization, homelessness, and other personal crises.

PTR leverages and evidence-based trauma recovery center model, delivering trauma-informed and culturally responsive mental health care and case management in 20 plus languages to thousands of people since our founding.

Supports individuals to build psychosocial wellness, deeply connecting them to community resources and each other, and supporting them and their loved ones.

We, like many of our sister organizations serving newcomer communities throughout the county, are facing unprecedented headwinds in terms of funding and stability paired with deeper and broader client needs.

We deeply appreciate the supportive approach of the behavioral health department in transitioning our collective prevention and early intervention work to align with the BHSA.

However, many community-based organizations like PTR are struggling to navigate the rapidly evolving landscape for organizations serving newcomers.

Additional stabilization funding for our prevention work is critical to maintain the community-based work that is essential for our diverse communities in the county.

I urge committee members to allocate a larger share of Measure W funds to stabilize providers like PTR during an unprecedented time of rapidly changing funding landscape at all levels of government and in the private philanthropic sector and pairing that with the expanded need.

We need more time and county support to adjust to these massive system level changes.

Thank you.

CCU, and then we'll move back to in-person speakers.

Good morning, everyone, and good afternoon.

My name is CCU.

I manage our text line services at Crisis Support Services of Calamita County.

We have seen a significant increase in contacts since the launch of 988.

Yet this is the exact moment our community-based prevention funding is being threatened.

Our community education partners build trust every day with every part of Alameda County from students in classrooms to refugees to health care providers.

Community education is how we ensure everyone knows when and how to ask for help.

As the State Department of Public Health determines the next steps in getting suicide prevention resources out to agencies, we can't afford to pause this work.

That's why we urge you to provide one year of bridge funding for all suicide prevention services.

Thank you.

And I would ask all speakers.

So if you want to speak, raise your hand.

We have 125.

Good afternoon, supervisors.

Good afternoon, Calony State Representatives.

Thank you so much.

My name is Daisy Vargas.

I'm a mental health specialist, part of Cultura y Bienestar Program.

Um, and I will read out a little bit of what I have written out.

Um we ask that you consider allocating the entirety of Measure W funds allocating to mitigate the effects of the transition programs to proposition one, BHSA or the maximum possible amount, such as our program Cultura y Bienestar, which is in Livermore, Union City, Hayward, and Oakland.

Would be covered.

These are essential services for us because they provide support in our own language and within our own cultural context and are located right within our community.

Our program Cultura Bienestar is a collaborative which includes La Clínica de la Rasa, Tiburso Vasquez Health Center, and La Familia Counseling Service.

Our program provides prevention and early intervention services for over 15 years.

Our program Cultura Bienestar highlights that culturally rooted approaches such as traditional healing practices, community connection, and culturally affirming spaces are critical protective factors for immigrant and Latino communities.

These approaches are not supplemental, they are essential to engagement, trust building, and positive mental health outcomes.

Prevention programs like Cultura Bienestar Program are also cost effective as they reduce the worsening of symptoms and decrease reliance on more intensive higher cost treatment options funded through state and federal systems.

Reducing funding for these programs risk weakening the very supports that help prevent more severe mental health conditions.

Additionally, the sense of belonging that is fostered through these programs.

When individuals connect with one another, share cultural practices, and feel seen and supported cannot be fully captured through quantity quantitative data.

Yet it is fundamental to mental health and overall well being.

The dissolution of collaboratives like ours, Cultura Bienestar Program, not only disrupts services but also erodes the trust, cultural connection and prevention and early intervention systems that community rely on, not as a luxury, but at my time.

Sorry, your time is up.

But we got it.

Next I speak on my language, Spanish.

Okay.

I think she's gonna translate.

Oh, okay.

Good afternoon, supervisors.

I am here.

Um in the past I've been here through um IHSS, and now I'm here in my role as a community participant for um prevention early intervention programs.

Okay, and HSA.

I want to share that measure W funds allocated to mitigate the effects of the transition to programs proposition one, BHSA.

We ask that you please consider allocating the entirety of these funds for our prevention programs.

This is to continue our efforts and prevention, such as our program that's doing these efforts, Cultura Bienestar program.

In the cities of Livermore, La Ciudad de Union City, Union City, Hayward y Oakland.

In the city of Livermore in particular, there are very limited services in our own languages to find services in prevention, early intervention services.

I am here to urge you that you consider supporting uh allocating the measure w funds.

Through my experience in the community and my particip my participation in the programs, I have had first hand experience in being able to see uh the effects that mental health has uh to reduce stigma.

So I've been participating in different uh efforts to be able to reduce stigma.

We see a lot of trauma, we see a lot of different symptoms that our community is affected by, and um, I also uh do see it in the elderly that I support through IHSS, that they are also affected, and through these programs, I'm able to share this knowledge with my community.

Right.

So uh if you can wrap it up.

Okay, okay.

I quiero decir others.

Um, a partir de que pasó lo del uh lo de la pandemia in the 2020, muchas personas adultas mayores, como mi edad, un poquito mayores, se insolaron in casa, no tenían como ir a buscar ayuda, buscar alimentos.

So, yo como trabajadora comunitaria de salud, me tomé el proposito de buscar ayuda in salud mental and cultura bienestar.

But we've exceeded.

You had two minutes and then two minutes for translation.

That's four minutes, and I believe you've gone way over four minutes, but go ahead.

With the onset of the pandemic, um, I had the opportunity to be able to reach out to programs like Cultura Bienestar, that is a prevention early intervention.

This served as a social support system to be able to access different services from food to navigating mental health and being able to gain further support.

So these programs are very important, such as Cultura Bienestar and other prevention early intervention programs that are speaking out on this day.

All right, thank you for your comments.

We need the services, please make um considering your decision making supervisors and the full board to be able to allocate measure W so that it could help mitigate the reduction and all the cuts.

Thank you.

Thank you so much.

Good afternoon, Chairperson Miley and Supervisor Tam.

My name is Valerie Gallo.

I'm the executive director of the behavioral health collaborative of Alameda County.

I want to echo the urgency you've heard from others today.

Providers across this county are already making staffing programmatic and operational decisions because of the uncertainty surrounding the BHSA transition.

The concern right now is that without sufficient bridge funding and formal stabilization commitments, programs are being forced into abrupt and chaotic reductions before there has been adequate time for planning, transition, workforce retention, or continuity of care efforts.

Many of these programs are people with the highest barriers to accessing care, including youth, justice involved residents, unhoused individuals, and people leaving hospitalization or incarceration.

Once specialized staff leave and programs shut down suddenly, the impacts will ripple across the entire behavioral health system.

Bridge funding is not just about delaying closures, it is about creating enough stability for providers to wind down programs responsibly where necessary, protect continuity of care, retain critical workforce capacity for as long as possible and avoid sudden disruptions that will deepen strain across the entire behavioral health system.

We would also appreciate the board's willingness to explore the possible use of county reserve funding to preserve critical prevention services moving forward.

As we've heard today, prevention programs are often the very services that keep people from entering higher levels of crisis care in the first place.

We're asking the health department and the board of supervisors to move quickly and collaboratively to provide bridge funding to reduce unnecessary disruption and help ensure this transition is managed in a thoughtful, humane, and responsible way.

Thank you.

Thank you.

Next we're gonna move on to our online speakers again.

Emily, you may go.

SI, SSDI, and Medical Advocacy to unhoused and disabled residents across Alameda County.

I recognize the county is facing very difficult funding decisions related to Prop 1 and broader behavioral health system changes.

While HAC is not a direct behavioral health treatment provider, our work is critical to stabilization services for many of the same residents impacted by these cuts, particularly individuals living with serious mental illness who are unhoused or risk of losing housing and continuing of care.

Helping residents secure SSI, SSDI, and Medi-Cal provides ongoing income, health coverage, and access to treatment and supportive services.

With those connections, many individuals are more likely just not to cycle through homelessness, emergency rooms, psychiatric crisis systems, and other high cost county systems.

This work will become even more important as new federal requirements under HR1 create additional barriers to maintaining Medi-Cal and other public benefits.

Many of the residents we serve already struggle to navigate complex eligibility and documentation requirements due to disability, mental illness, or homelessness.

Increased administrative burdens will make advocacy and benefits support even more central to ensuring residents do not lose access to health care and income supports.

Benefit advocacy also helps bring federal resources into Alameda County and reduces long-term pressure on county funded safety net systems.

As the county considers bridge funding and stabilization strategies, we were specially asked the board to explicitly include SSI advocacy, medical advocacy, benefits advocacy, and related legal services within the restored or bridge funded safety net program connected to Prop One impacts.

Thank you so much.

Kate, unmute, please.

Okay.

Hello, this is Kate Watsworth, aka Kate's iCON from CRA, Center for Empowering Refugees and Immigrants.

I wanted to thank our partners at BHSA and all your hard work during this transition and the many challenges.

And the Prevention Matters Collaborative urges you to keep the UELP funding whole through the $7.7 million, which allows all the UELP providers to provide sanctuary spaces, which is essential.

Mental health mental health is on a decline, which threatens the entire Alameda County community.

Immigrants and refugees are an integral part of what makes this county so amazing.

And having these spaces where they can celebrate their unique cultures and get services from their communities who speak their language and have shared experiences.

As we all know, the increase in ICE rates across California and the current federal administration budget cuts are deeply impacting refugee and immigrant communities here in the Bay Area.

Our clients have seen the absence of due process, detention of legal permanent residents, deportations that separate families, worry about their public benefits, and the threat on students and refugees with approved visas.

Our clients are reminded of the traumas that they survived and lived in fear of deportation and family separation.

At a time when refugees and immigrants need it the most, our programs offer essential services that are vital to the county's broader homelessness prevention strategy.

We cannot leave marginalized refugees and immigrant communities behind.

Thank you for listening.

Go ahead, Jen.

Good afternoon.

My name is Jen Marshall, and I'm the community education director at Crisis Support Services of Alameda County.

I'm here today to speak for the more than 10,000 students our Teens for Life program reaches each year.

For students in Alameda County, our presentation is often the first time they learn what support is available and how to access it.

They see real examples created by other students, and for the first time, many realize they are not alone.

We aren't just giving a speech in front of a classroom.

We are generating disclosures.

Every time we walk into a room, students come forward afterwards to tell us that they are struggling in crisis or thinking about suicide.

Our staff then connect those students to support and resources.

We know this saves lives.

Right now, because of BHSA funding shifts, we are facing a gap that could lead an entire school year of students without this essential education.

You cannot put a teenager's mental health on pause for a year while we wait for state funding.

Please fund this bridge so that we can continue to empower youth to care for each other and ask for help when they need it most.

Thank you.

All right, we're gonna go back to in-person speakers.

Noha Abulada, Andrea Henda, and Preet Sab Harwell.

Good morning, supervisors.

I am Noha Abalada, CEO of Roots Community Health.

We, of course, support a one year bridge.

But I think we need to be clear this isn't just about a budget gap.

This is about the permanent dismantling of decades of safety net infrastructure.

When you wipe out suicide lines and peer support, we lose lives, and it costs significantly more to rebuild this infrastructure later.

Roots was brought into the specialty network through an RFP specifically to solve cultural scarcity in East Oakland of mental health services, especially for reentry.

To disenroll us now is to evict the safety net from the neighborhoods you've tasked us to serve.

And as a system, I don't think we can afford to disenroll any certified provider.

The work to get certified to be clear is intensive.

It's too intensive to waste, and our network is too precious.

This is our safety net network.

We also need transparency regarding our actual capacity before we begin dismantling.

We need to understand our true network.

We need to make sure we aren't projecting capacity on paper.

We need to be assured of our true network adequacy because you are locking providers like Roots out of the network now and out of the digital systems like smart care required for us to safely treat patients.

Also, the fiscal impact goes beyond reductions to leaving federal funding on the table.

Because our patients are in the adult expansion population, they bring a 90% federal match.

So for every $10 the county saves by cutting base funding, it forfeits $90 in federal revenue.

This is not savings.

This is going to be disinvestment of our very safety net.

I do feel confident that we can solve this with our own resources and brilliance that we have.

We have our own certified public expenditures that we could be leveraging, but we need the administrative will to keep all existing points of access open while we figure this out.

Finally, January 1st is going to bring a redetermination cliff with six months renewals, work requirements.

Our patients are facing a gauntlet of administrative hoops.

If you dismantle the trusted providers who help them navigate these hoops, they will.

Only then the costs will be mostly uncompensated because they will have lost coverage and will be shifted to the county.

So a year is perfect.

Thank you so much.

I hope that there will be no doubt that there will be a bridge, but it is short.

We will need this year to develop a cohesive stakeholder-led Medical strategy for our county.

We heard first five, we heard ACOE, we hear the FKCs, we hear Alameda Alliance, we have mild to moderate modern to severe, we have networks that are overlapping.

We need the 12 months to work on a cohesive strategy so we aren't facing this cliff again in 12 months.

Thank you.

Hi, I'm Andrea Henderson.

I'm the clinical director at Crisis Support Services.

Um, our team provides community-based grief groups with a focus on those who've lost loved ones to suicide, homicide, and other traumatic losses.

We meet residents in libraries and senior centers and in communities around Alameda County.

We meet with people to address a fundamental truth, which is that unaddressed grief is a primary driver of future crises.

When loss is left unprocessed, it's fires into the very depression, substance abuse, and homelessness that Prop One aims to fix.

Our low barrier drop-in sessions catch people before they lose their jobs or their housing by providing this upstream support to prevent the downstream collapse.

We're looking for bridge funding to keep these neighborhood lifelines active while state funding timelines align.

Thank you.

Good afternoon, supervisors.

Thank you for your time today.

My name is Breet Gore Subberwall, and I'm the clinical community program director at the Hume Center in their South Asian program, a prevention early intervention program funded through UELP funds.

For the past 13 years, my work has focused on the South Asian community, specifically the Punjabi community here in Alameda County as one of the few Punjabi therapists in the region.

This community is often seen as wealthy, educated, and self-sufficient, but this stereotype masks the real challenges many face, which include poverty, housing instability, mental health stigma, domestic violence, and lack of access to services.

The MHSA funding has been a lifeline for the South Asian community.

With the transition to BHSA EI opt-in requirements, we're expected to serve 90% Medical eligible members at the same time that many of our immigrant and refugee community members, survivors of abuse, and others affected by changing eligibility criteria are losing Medicail coverage.

This leaves only 10% of outreach and engagement capacity for communities that are already unserved, underserved, and inappropriately served, creating the devastating reality that many will have little to no access to mental health services at all, which is contrary to the county's priorities and the state's commitments to equity and access for vulnerable communities.

We are appreciative of Alameda County behavioral health for keeping us whole this next year and for the option to transition to EI.

However, we are being asked to change our service delivery.

So we aren't preserving our UELP program services.

We're only supporting treatment services.

ULP services are being dismantled and still need to be funded.

As a member of the Prevention Matters Collaborative and the Behavioral Health Collaborative of Alameda County, we urge you to prioritize mental health prevention programs, recommendations for our immigrant, refugee, and indigenous communities.

This is the time to use the reserve to support these community-driven, culturally responsive services.

We want to do prevention first and not fall back into the fail first approach.

Thank you for your time and support.

All these people signed up within the time frame.

Yes.

How many more speakers?

About 12 in person and just one more online.

All right.

Because I would like to get a vote on this, but go ahead.

Okay.

Maury, go ahead.

Good afternoon, Supervisor Miley and Supervisor Tam.

My name is Maury Chom, and I came to the United States as a refugee and immigrant child, a daughter of genocide survivors, and I wish there were intentionality in mental health prevention programs that were culturally and linguistically congruent for my community when I was growing up.

Today I serve as the director of population focused mental health prevention and early intervention programs at Rams.

I am a board member at the Center for Empowering Refugees and Immigrants, and I am a member of the Prevention Matters Collaborative.

And I am here today to urge you to please fully fund underserved ethnic language populations in prevention services.

As a public health professional, I strongly believe in the power of prevention.

I believe the best mental health systems are not built only around responding to crisis, but around preventing crisis before it happens.

Every day I get to work alongside immigrants and refugee communities, Pacific Islanders, and other indigenous communities, leaders, youth, elders, and low-income families who are navigating housing instability, economic stress, trauma, isolation, and fear around immigration and health care access.

What I see every day is that UELP programs and services work.

Prevention may not always be visible in the same way crisis response is, but its impact is profound.

Prevention is a young person finding support before they reach a breaking point.

It is a family receiving culturally, linguistically responsive care before stress turns into crisis.

It is an elder finding connection and community before isolation becomes depression.

These programs are effective, and my time is up.

I have a lot more to say, but I will end there.

Please save our programs.

All right, I'm going to call all of the speakers in person.

Please line up at the podium.

Clary Villagras, Tizita Techla Sadiq, Catherine Schwartz, Helen Tong, Alison Monroe, Jet Leo, Julian Carter.

Telony Perez from the Mental Health Association for Chinese.

Living in Castro Valley, Norges Dillon, Rosemary Laguva, Tony Panada, Raquel Vasquez, Nisha Backden.

And this is Tizita again.

Good afternoon, Supervisor Tam, members of the public health department.

My name is Clary Villacres.

I work with Clinica de la Rasa in Auckland, part of the collaborative Culture Bienestar.

I deeply appreciate the ongoing efforts to protect the continuation of funding for prevention and early intervention.

I'm here to support and respectfully request the protection of funds beyond fiscal year 26-27, dedicated to prevention and early intervention services delivered by setups.

Programs that work with underserved communities.

These programs secure access to critical services to diverse populations and have a multidimensional understanding of early intervention.

At the same time, many of these services, as mentioned earlier, are particularly not well suited for medical billing and state funding will not be sufficient to sustain even minimal levels of service.

Without the support, the impact would be really severe in the mental health suffering of our communities.

Thank you so much for that early support.

Good afternoon, Supervisor Tan.

My name is the program manager for the ELG program at Partnership for Trauma Recovery, serving the African communities.

I'm also speaking as part of the prevention collaborative matter, whose request is 7.7 million in funding to sustain the ULP prevention service as a whole.

For nearly eight years for the African Communities Program, we have provided cultural responsive mental health and healing service to between 2000 and 2,500 community members every year.

Our program has done what many systems struggle to do, build trust and enhance service seeking behavior within immigrant communities.

Through support group, collective healing, preventive counseling, we created a space where community members felt safe enough to seek mental health support without fear, stigma, and shame.

Today the trust and those services are at risk.

Propoin now ties service more closely to diagnosis requirements, medical and medical care eligibility, and shifting population priorities.

The reality is that many underserved and invisible communities members will no longer qualify for support until they are already in crisis.

At the same time, we're living through a growing fear, instability, anti-immigrant rhetoric, housing insecurities, and cut to medical and medicare.

These pressures are deeply impacting our communities.

Prevention programs like ours are often the only trusted bridge, keeping people connected to care before problems scaled into emergencies.

So this program is not just a service, it's a lifeline.

It addresses isolation, trauma, economic hardship, the daily stress that immigrant family face.

When people lose cultural responsive prevention care, they do not simply stop needing help.

They become disconnected, isolated, and more vulnerable to crisis.

We know this model works because we have seen thousands of people heal, connect and seek support in ways that are culturally safe and inclusive.

Losing this program would mean losing trusted relationship, specialized staff, and years of COVID trust that we cannot easily be built.

We urge the board of supervisors and also thank to our look at major W funding to sustain this vital prevention service.

Please do not allow immigrant communities to lose access to care because funding priorities changed.

Because I think we got it.

Good afternoon, Supervisor Tam and Chair Chairman Miley.

My name is Catherine Schwartz, and I am the CEO of Alameda Family Services and a member of the behavioral health collaborative.

Everyone in this room shares a fundamental commitment to the well-being of the most vulnerable residents of Alameda County.

People with the fewest resources and the most to lose when systems fail them.

That shared value is the foundation of what I want to say today.

I recognize that there are real barriers, competing departmental priorities, evolving state expectations under Prop 1 and the Behavioral Health Services Act and genuine fiscal pressures.

We understand that.

We live alongside you.

But the services at the center of today's bridge funding conversation are core to the behavioral health continuum of care.

They reach people at the intersection of mental health, housing instability, and poverty.

There is no soft landing.

If these programs are interrupted, people will fall through the cracks.

I have faith in Supervisor Miley and Supervisor Tam, and I want you to know how much I appreciate you today.

Deeply, deeply appreciate your questions, your thoughtfulness, and your commitment to this solution.

We are on the precipice of something really frightening.

But I am seeing today everyone, the ACBH leadership, supervisors, everyone in the community pulling together and really putting the well-being of the residents of Alameda County at the center of the decision making, and that's exactly what we need to do.

Thank you so much.

Good afternoon.

Thank you for your leadership at the time.

My name is Jet Liu, debut director with the Mendel Health Association for Chinese community.

We provide the case follow-up, emotion support, and the Christ big escalation through our two mobile apps, one eye in person service.

As a county discussed property one and the bridge founding today, I want to remind everyone that culturally responsive community programs are often the first place families' term before a crisis becomes a tragedy.

One recent case involved the young woman in Freeman experienced a mental health episode.

She ran away from home, wandered streets, and was sexually assaulted a couple of times while we're in a wallable state.

Her parents called our one night.

Our teen worked with the family and the law enforcement to locate her location and connect her to the treatments.

She was established and the safety return home instead of continued to or long-term homelessness.

This is not just prevention.

This is real intervention.

This save lives and reduce far more costly emergency response later.

Today, MHACC service are at risk due to major funding cuts.

Our staff has been reduced from 70 to 6, while our one night still handles more than 2,000 contracts in Alameda County each month.

So we are we are respecting about 850,000, one year night night funding to keep this essential service operating.

We respect ask the country to support community-based organizations like Mental Health Association for Chance Community.

Thank you so much.

Yeah.

My name is Helen Fong.

I'm currently working at Villa Fermone facility.

I'm on a supervisor for the above facility as a psychiatric technician.

I met Elaine Payne, executive director of mental health association for the Chinese community, twice at Villa Fermone facility.

She came to visit her client on one-on-one base and follow up her client's progress.

I witnessed that Helen Penn can actually run for an extra mile to ensure her clients were being taken care of.

But there was a uh any further need for her clients.

From a 33 years in nursing career to have a chance to meet a member from a nonprofit community association, come to visit the client personally is very rare.

From my point of view, Elaine Peng is an exceptional kind and caring person.

She takes her job seriously.

Her good deed is inspiring and should be acknowledged and appreciated.

Recently, uh the uh Elaine Penn to say that her nonprofit community-based association funding is at risk.

I just wonder why the funding to be at risk, especially this challenge mentally ill individually.

It has so desperately funding and the resources will be automatically affect the quality of care quickly.

Very obviously, this community-based association has cut down the staff from 70 members to 30 members and now down to six pay um six members.

And they have the uh county content.

About 2004, I mean uh contact, you know, per month.

I hope the in order board to uh reconsider to allocate sufficient funding that's needed to help these uh people, you know.

These people are far less fortunate than us, and you know, please give them a chance, you know, uh hope to have a better or to improve their life.

I sincerely hope that the county to support this community-based organization, the Mental Health Association for the Chinese community.

Thank you.

Next comment.

Good afternoon.

Thank you both for hearing us out and all your questions today.

My name is Narja Sohori Dillon.

I'm the executive director of crisis support services of Alameda County and past president of the Behavioral Health Collaborative.

I want to express my sincere gratitude for the stated commitment to bridge funding.

You've heard from my team today about the lives at stake.

In the last year, there's been a 59% increase in 988 calls in Alameda County.

That tells the story of a community already struggling.

It also tells the story of a crisis system that's not able to absorb more if all these other services were impacted.

But I'm not here to just talk about my agency.

I want to talk on behalf of our network of providers.

A verbal commitment at this point in the year is not sufficient.

We can't plan, we can't retain specialty staff, we can't maintain clinical safety nets based on the possibility of funding.

Without a formal written commitment, these programs will continue to shrink and some will disappear by the end of next month.

We're currently allowing procedural matters and administrative timeline to dictate the survival of our safety net.

Do not let the data, we have the process destroy the what of our shared mission.

Thank you.

Good afternoon, supervisors.

Um, just want to thank everyone for the collaboration.

This is a great thing to see during this time.

My name is Rosemary Laguna, I'm the CEO of Peers.

Um, we have several prevention programs.

I had to make the tough decision these past couple months to shut down some of those programs and to lay off some of our employees.

We have a couple of prevention programs that we still have running that we're hoping with some kind of funding that will help continue that.

Um, I want to stress how important prevention is.

Remember, we interrupt the cycles of trauma, substance use, and mental health crises before the escalate.

This is very, very important.

We should not be waiting until they have escalated and they have severe mental health diagnosis.

Some kind of funding would be very, very important to us.

The reason I say this is the cost of prevention is far less than the cost of crisis.

Without these programs, we will see the increase of hospitalization, more strain on emergency systems, and a deeper harm to our communities.

This is just not about funding an organization.

This is about investing in the people.

It's about protecting our community from falling to the cracks and ensuring that everyone is part of getting some support and not being forgotten.

So I truly, truly ask that we really look at some kind of funding for our prevention so I don't have to continue to go to the point where I have to shut down my organization.

Thank you so much for your support.

Hello, board of supervisors.

Thank you, and thank you to the leaders over here because I know they're working overtime to make this happen.

I want to just say I'm Nisha Beckton.

I'm the executive director and founder, co-founder of Pathways to Wellness Medication Clinics of 28 years next month.

And we provide specialty mental health for consumers in this county.

I want to say I've been in Alameda County for 35 years as a clinician as well as now as an executive director, and everyone is hit on all of the critical things.

I believe we all are in agreement.

I just want to walk away with saying five key points for me.

One is continuity of care and health equities, specifically for African American mental health consumers.

I want to make sure they're not left behind in this process and that we start with very solid data tracking.

I heard Dr.

Tribble talk about new reporting requirements.

I like that idea that the state is presenting, and I would like to see that data go into the system so we can make sure that everyone gets served.

I also agree with Dr.

Noha around the Medical strategies.

That's going to be critical that we get that in order.

The outreach and education is, I cannot emphasize the importance of that.

We see a hundred new consumers, mental health consumers in this county every month we take in our facilities.

And so I know for a fact a number of clients are already saying they don't think they have medical services anymore.

So the education and outreach is going to be critical so that we can continue in Alameda County for everyone.

Suicide prevention and crisis services is critical.

Narges, thank you.

I believe that that is especially important for this county.

I have been involved on a suicide prevention group now for the past three years, keeping hope alive.

And I know for a fact we are losing lots of children and African American individuals.

The next thing is any deltas or gaps that we have in the budget.

I believe it is critical that we share a clear plan for mental health coverage and what we're going to do with those gaps.

Lastly, number five, funding timing and what that will look like and what that means for providers.

Let's make sure we keep them in the loop and all the way because they are making this happen and we don't want to lose any providers.

Thank you.

Hello, Tony Panetta with Alameda Health Consortium.

I'd like to try to keep my comments short that I'm here to say yes, and please.

We support the year-long bridge strategy to provide providers a longer off ramp for continuation and transition in the programming.

We also appreciate the consideration of the proposal put forward today to identify additional funding to offset the effects of proposition one.

We also heard and agree with comments related to the importance of prevention.

And this is where my and comes into play, that prevention extends beyond mental and behavioral health services.

So we would encourage consideration for the full safety net.

We don't want to be having the same conversation about other parts of healthcare services that our communities are going to be seeking.

We do know and understand that state decisions in the May revise will be important to provide transparency.

We understand that you all are managing processes for county budget, measure W spending decisions, measure W prudent Reserve decisions, and other prudent reserve dollars.

We would encourage you to keep this in mind to stabilize the totality of the county's safety net.

We want to be clear that community clinics, community providers who are medical providers, federally qualified health centers, are facing the prospect of severe destabilization beginning in July, that our partners here and providing mental health services could face a risk of RFQs not being able to receive referrals.

So we want to continue conversations about having an overall stable health care safety net.

Thank you.

She's a 16 two years old died in home by suicide.

Her husband later told us if we had no this was uh organization like met, um maybe my wife wouldn't will will be still relied aligned.

Uh I want to mention how a mental association um of um mental health association of a Chinese Americans, you not only do the prevention, she also save lives every day.

Uh Asian woman, um, she to speak a little bit um uh English, broke down in OPD uh um Oakland police department of the years of the abuse.

She's diagnosed PDSD and she had been living in her card.

Our team can her and how her asset uh the shelter and connect her to the support housing and treatment.

When he signed her lease, he said I finally had the home.

Our woman is offered often the first race they can turn for the emotional support crisis and education.

And our organization face very serious challenge.

Yeah, thank you, Dr.

Chibu.

Yeah, how had the support letter for the state funding?

But we've done the new funding, the live, we will be consent to shut down.

So we tried uh respect us the county to read your funding to how as the base uh service line um met before the most family lose someone they love.

Thank you so much.

Thank you.

So Raquel Vasquez vengo de la comunidad de Libemur, apoyando la gente, the gente mayor, the uh cultura y star.

Los uh los apoyos.

Good afternoon.

My name is Raquel Vázquez, and I live in the Livermore area, and I'm curious.

I'm here to represent the elderly population, and in particular, the program, Cultura Bienestar Program.

I ask that you consider not cutting these programs that are prevention early intervention programs.

I have a lot of elder friends who I connect with and who tell me that they have lost hope.

Some of them saying I don't want to live, and I share with them about the programs such as Cultura y Benestar that they hold, to be able to continue to participate in these programs so that they are able to improve their well-being.

I encourage them to engage in different activities so that they could continue to improve their well-being.

And some of them it's to the point that their mental health is such at a severe level, including that they mentioned that they've lost hope, but they have no reason to live.

But I engage with them and connect with them.

Thank you.

Thank you.

Thank you.

I yield.

A yield.

Okay.

And I believe that's the last speaker.

Okay.

I thank all the speakers for their comments.

And let's uh bring it back to the committee.

Um, let's see.

Oh, let me ask Dr.

Treble a question.

So as I understand it, Supervisor Tam's suggestion is that we use nine million of the carryover in year three to help deal with the reduction in MHS services at this moment around prevention.

Um, will that have any impact on our ability to submit the integrated the three year integrated um plan?

Uh yes, there are multiple uh implications, and I I want to uh also make sure I understand Supervisor Um Tam's request.

So we will not be able to use uh any of the carryover in future years, for be it to say we can use the carryover in year one.

It will not allow us to meet our uh 14th deadline of this week.

So then the county will then be uh out of compliance in order to adjust and move the nine million to year one, we can restore that providing them and not prevention.

We then would have to also cut programs in year two and three.

And uh so that would be just uh an honest, we would have to then update that.

Um if the cadence of the funding and whatever else happens through Director Trotter's office in terms of um allocation of measure W, if that doesn't happen, we will still need to submit a plan.

So we have a few options.

Um if we do that, we delay, we will be out of compliance, the state's asked us to, you know, also not just us, the entire state.

We will not have that available because we'll have to redo our entire plan.

And then um the state has that uh 30 day period where then they review the changes that we made.

We've had have already essentially completed that first set of 30 day review, and so the only changes we've made were they've asked us to do descriptions.

This type of material change is going to push us back.

So the implication is that there is also a potential delay to the start date of July 1st.

We will not have an approved plan by which to operate from.

So if that's the case, then uh your board would then need to consider what that might be in terms of impact.

If we submit changes after this plan that the state has already vetted, that will not put us out of compliance.

If your board allows us to put forth this plan, we can then uh provide an updated change.

It would still require changes to years two and three unless we identify other funding.

The other piece that are we huddled on just literally today is we would rather uh the uh director Charlie has has allocated 15.2 million for us to determine how we would it's not optimal.

We would rather reduce that amount by nine million if the desire is to lessen the impact of uh use of measure W.

Uh, if that's the case, that would then just be about 6.2 million dollars in restoration, but and so those are a few options.

Go with the plan, make the changes later, make the changes now, be at a compliance, delay start date, and or we're willing, we just want to have a truthful three-year bridge, and that's what we had factored into the plan.

Okay, um I'm gonna call on Supervisor Tam in a minute.

So, as I understand it, if we go with what's suggested, it could have significant implications.

If we um don't go and suggested, you're saying we could take some of that 15 million in measure W and reduce that amount to deal with the uh the um the reductions.

If there's a desire to uh maintain nine million dollars to not commit it from um measure w, we could do that.

That's the third, but there is a second option that I just want to make sure uh that we can submit the current plan as is, then look as supervisor Tam suggested, which could still be a reduction in uh whatever that looks like, but yeah.

So once again, I um I'm just gonna uh state my preference would be that we submit a recommendation to the board on the BHSA three-year integrated plan as proposed.

If there needs to be some adjustments made to it, we make those adjustments prospectively that we provide bridge funding.

Um to 17 million dollars of measure W, from either the essential services bucket, the home together bucket, or the prude and reserve bucket.

These uh providers, I mean, I think providers for mental health uh prevention have been coming to us.

I think for at least the last two years, and we've been telling them we were gonna address this, because we kept telling them we're not addressing it in this budget cycle because it's not um timely, so wait for the next budget cycle, then we said um we would get to it, and then you had to make the put together the plan for BHSA.

Um, so we've continued to kind of delay making the decision on this.

I think we need to bring this to the board next week with a firm decision that we're gonna use 17 million dollars of Measure W.

This is on top of what's already been proposed to ensure restoration of the um MHSA uh services.

I think that's the prudent way to go because it doesn't jeopardize you not being able to submit the plan on time, the BHSA three-year plan on time.

One, two, I think the staff has spent a considerable amount of time working on this uh for more than a year, and I don't want to have I'd hate to have to go back and try to you know do additional work on this between now and next week when we can submit something and hopefully get it approved by the board, and if we need to adjust it in the future, we will make those adjustments.

So that brings um, you know, it lessens the burden on staff in terms of work, and then three, it would provide certainty to the CBOs that need certainty on the fact that we're gonna restore um funding for uh MHSA services that are being cut.

Um, once again, the 35 million that is being uh proposed uh by the agency director, and then the 17 million that I keep pushing for out of measure W.

Um the when we were considering what to do with behavioral health under MHS MHSW uh MHSA, prior to Measure W being legally approved for us to use, we were collecting the money, and if we'd taken action to use some of the money at that point in time, we'd have been kind of betting on the cum that we're gonna win on this.

We're not betting on that now.

We have the money, we have the money, we have the money, it's there, measure W sunsets in five years or thereabouts.

Should we want to reauthorize Measure W, either through a citizens initiative, or if the board puts on the ballot, we'd probably be looking at that in 2028, 2029 fiscal year or 2029 30 fiscal year, so that if it doesn't pass, we'd have one year to kind of go back out to the voters.

I say spend the money.

I can't express it enough.

People have expressed that prevention is better than crisis, the reserve money is there.

There's no better use in using the prudent reserve money now than waiting.

I've also stated that if we've set aside 170 million dollars of Measure W as a prudent reserve, and we're now in fiscal year, can ready to go into fiscal year 26, 27, and it sunsets in fiscal year, let's say 20 uh 30, 31, that's five years.

If you divide the prudent reserve by five years, that's 34 million.

We can easily take 17 million from that prudent reserve right now and deal with this problem.

Deal with this problem now, bring certainty, stop the staff having to spend time dealing with this and deal with it.

Get it behind us.

If you have to adjust it, if we adjust it, we adjust it prospectively.

If we have other needs, which I know we have other needs, AHS, the clinics, God knows we got so many needs.

We will look at those, but right now we're dealing with the prevention piece.

So I want to move ahead with this.

Um I gotta wait for my colleague to get back because I'm preaching to myself now.

Um, so but while I'm waiting for uh, does this Dr.

Tribble or the agency director?

Do you have any other comments on this?

Because I just really think we need to move on this.

You know, no comments.

Just waiting for the motion.

Okay, okay.

Any any further comments?

So let's see what Supervisor Tan has in terms of questions or remarks to see if we can advance both the integrated plan as well as the bridge funding.

Um, and you think you could do it on May on May 19th next week as a special meeting.

Uh so for the bridge, we would like to bring that forward.

And I'm hearing you up to the 17 because I wouldn't be doing my full job if I didn't say we could trim somewhere.

Um, so we'd like to bring that uh that portion forward regarding the timing for the three-year plan.

Uh, I think because behavioral health has to provide an update to the state by the 14th of this week, we could also share a summary with you all of any changes or or uh what was put in there because I think most of the changes are gonna come from the carryover plan.

Uh so if that's helpful to the board to just have that context so that when it comes to the full board, you're aware of what that is.

So if I understand right, you could share that on the 19th and then bring the decision on June 2nd.

I believe they're aiming for the 16th for the plan approval.

I yes, and I think the the only piece we would say is uh whatever we come before you in terms of BHSA, certainly there's the Measure W, would be uh separate.

So the information would have to be consistent, yes.

So what we can provide any supplemental information, anything Director Trava request, we can provide that supplemental information um in order to meet the timeliness standards for sure.

And I think you had also wanted a drill down on the services for housing.

So we absolutely we could quickly provide that as well.

But one comment, because I think uh Director Umby had said something.

When do you need to have the plan to the state?

The 14th.

Of June.

Yes, they have already reviewed our plan, have essentially approved it, but now we have the calculations.

They want to reevaluate that with the calculations and that's the board meets on June 2nd.

Do we have another meeting after June 2nd?

Yes, is that budget or is that just a regular meeting?

Um I believe the 16th is a regular board meeting.

But the June, but the 16th doesn't work, they need to have it at the state by the 14th.

So the uh the what needs to go to the state on the 14th of this uh this month is an updated spend plan because of the error that the state found in their templates, which sort of affects how the um uh how the carryover was being counted.

So the state has asked all behavioral health departments across the state to adjust that, so they need to submit that to the state, um, and then it would still need to come to the board for a final approval by June 30th.

Well, we've been aiming for June uh 16th.

Okay.

Okay, okay.

Because we don't want to get our backs up against the wall because we already kind of getting our backs up against the wall with the integrated plan.

So we've got the integrated plan and we've got the bridge.

That's all right.

You asked me one you asked, did I have any the only thing I would say is regardless of what happens?

Uh the department would then prepare because I really do appreciate Supervisor Tam saying uh the concern is not just for the department, we're concerned really for the whole safety net, all of those that receive funding across the uh county.

We would then internally be looking for mechanism to pay them.

So i.e.

whatever cadence is happening with measure w, we then would be looking to your board at some point um for some approvals to ensure that we can pay them uh to the extent that the measure w funds are also provided.

Okay, so Supervisor Sam.

Um I've dominated the question and comments since we've heard from the speakers.

Um so I'd like to see if you have any questions, comments, and kind of give us a sense of of what you think at this point in time.

Um I appreciate all the speakers coming up because most of you, actually, all of you, are uh part of the provider network in which we, the county, has made such significant investments in that infrastructure, and you provide the services that are so critical to the county, especially uh when it comes to mental health and early intervention in a way that is also reflective of our community and our culture that we have uh that need, especially uh given our state with um the immigrant population.

The one thing I've been trying to do is try to give as much flexibility and options to our department, uh, because I think one of the speakers talked about the importance of preserving and stabilizing the totality of our health care safety net infrastructure.

And what we're gonna be seeing, and that's why the department had uh put together, I think 15 million dollars uh to deal with potentially uh the contraction and medical with respect to the unsisfactory immigration status individuals, of which we have 70,000 in Alameda County.

So that's going forward.

So that's the reason I wanted to make sure that there is as much flexibility and I appreciate the compliance challenges, but you know, frankly, we've done this in prior years when I've been on the health committee, and it's just we do give you the flexibility to make changes after the board or the health committee moves forward before the board fully adopts, and I wanted to make sure that flexibility was available this time around as well, because you just told us that the state made a mistake a couple days ago and told us we don't have 25 million dollars or something.

That is true, and you're absolutely right.

We've done that in years past.

That is one challenge would be HSA is not as flexible.

So that's why again, depending on how your board operates, that $9 million can't be like it could be in years past, used interchangeably, and that's why it actually would result in cuts.

But I appreciate I certainly you would like to make sure that we cover and support the system.

We definitely uh support that as well.

But I think that is Prop one is is unfortunately more rigid and as a little bit inflexible.

It perhaps we imagine that since everyone is going to be going through this, the state may revisit, but they have limited and what we can use the dollars for and categories.

I know prospectively going forward, but we have this unique opportunity this now because it's MHA funding carried over, right?

Uh it is, and we can only use it for one year, and then that's why it then affects the other two years.

Then you can only use BHSA.

And so if that MHSA paid for things that is no longer applicable under BHSA, that's why it would result in cuts to years two and three.

We would just not have the flexibility to move it forward.

All of it is possible, it just depends on how you are.

Right.

And that's why I wanted to give that opportunity and option to use it in year one when we re really need the funds now and to roll it over.

I mean, excuse me, to include it and align it with a lot of the other um budgeting items that we have already included uh for under Measure W for the Prop One transition.

So that was the reason I wanted, but I mean, if the I want you to be compliant.

I want us to be compliant.

So I don't have an issue if you want to have us move this forward to the full board as an integrated plan with the recommendations, but you're going to have to make changes anyway.

Correct.

And so the compliance is significant because we uh the question was what would happen, i.e., if we don't comply, we imagine sanctions.

You know, BHSA is now about accountability.

So there would be impact, uh, and we've not asked.

But if we don't do it, uh, we've had just been compliant as as other states.

Um the piece again for for us, it is absolutely possible, but to use BH's MH's say carry over year one will then result in year two and three cuts within the plan.

Then the state would have to review that again.

And why I mentioned that is these are would be material changes.

Uh they've already reviewed our plan, they've asked to provide more detail about programs.

That's nominal in terms of that.

They haven't asked for any changes, but if we do Ludin shift it up, it shifts and changes the allocations in two or three.

And in order for us to be compliant, we've already notified providers, but we then would have to notify them again to truthfully to match our plan because we would not be able to fund that many an X component based on that.

So it is, it is just literally as you mentioned, hoping for the more flexible model, and because of the way that prop one is structured, it's not like the images say any longer.

So our plan update will be able to say how we use the money, and then it can show if there are other revenues.

If Director Travelly uh provides more to the behavior health system, we can add that in our plan and we show that.

Um, but technically we don't have an operating plan at all.

And that was the difference also within me to say we at least had plans so people could continue to provide services in that way.

But right now, there this is the first uh flagship prop one plan, even making it more difficult for our entire county and the system, quite frankly.

So okay, I I know we're in this boat because of Prop One and I you I just want to make sure you know the board did not support Prop One as a whole, but here we are because we knew this was going to be an important part of our um impact, our infrastructure in terms of prevention and early intervention.

So uh having said that I'm comfortable uh moving the three-year um integrated plan to the full board, and then I'm also um comfortable with the direction in terms of um getting a bridge funding plan in place that looks at every opportunity, every bucket that we have to uh maximize um our funding stream so that we don't see these impacts on our providers.

So does that mean the 35 million plus 17?

I'm not gonna commit to any funding at this moment, but I want full restoration too.

So you're does it's full restoration.

Okay, all right, okay.

Um I understand it.

Then the motion is that we advance the BHSA three year integrated plan to the full board as presented, proposed to the health committee, one, and two that we look for full up to full restoration, up to full restoration of the MHSA um providers that have been um subject to a reductions.

Yes, that's the motion, and I second that motion.

And I'd like can we I'd like this to be brought to the board on at a special meeting on May 19th?

Can you do that?

Yes, you can do that May 19th next week.

Yes, okay.

Any any other any questions or concerns?

Nothing you haven't heard before.

Okay, very good.

Um, and then the further, I just want to also see if in the motion we can also say, because one of the timely timelines and next steps, it calls for contracts and funding effective July 1st, 2026.

And it says notification to providers pending board action.

So if the board takes action on this on May the 19th, what would be your next steps?

So uh supervisor, what we could bring to the 19th is here's a package with up to 17, um, up to the full restoration.

Uh, and we would uh that would give us the green light to then go ahead and talk to providers.

Um also on the seven on the 19th, we'd like to bring forward at least the the framework for uh the types of permissions we might need in order to uh just expedite the process um so that you're aware of essentially what would come in the board letter on the second or the 16th.

Okay.

On when?

On when?

On the second.

On the second, because you know, these providers, you know you you know it.

They can't wait.

Yeah.

Some have already made layoffs, some have already made cuts, uh, it's having impact on staffing, clients, safety net.

So they can't wait any longer.

So we need to get this resolved.

So all right.

So you know, if you can do it on the 19th, and clearly lay out and get permission from the board, that would be uh hopefully our preference.

Yeah, we can do that.

And then I just, you know, you did ask what I wanted to add before.

Again, they just really really want to iterate it's a one year bridge.

Yes.

Uh, we're committed to working with providers in the in during that time.

Um, but we just are headed into a world where there the system's just gonna keep bringing more pain.

And so uh again, I appreciate you know that uh we'll continue to move forward with keeping our communities at the forefront.

Um, and we also have to be fiscally prudent at the same time.

Yeah, because I think uh, you know, Dr.

Noha expressed it well, um, and what you put down here, 6 30 2027 one time bridge funding ends.

So between the action the board takes and uh the end of next fiscal year, we have to roll up our sleeves and and look at this more comprehensively as well, with because like January 1st, that's when the HR1 work requirements and other things become effective.

So we're that we need to look at it all holistically, but at the moment, we're kind of being iterative at the moment.

Okay, and then the other piece I just want to say, I'm gonna see if Supervisor Tam is comfortable with this.

Even if the board approves this on May 19th, um if you need to get authorization to advance funding to the providers, include that, you know, advance, maybe because I've said maybe advance up to 40 percent.

But if you need authorization, get that in the uh before the board as well.

I'm not saying you have to advance 40 percent, but up to 40 percent as an as an example.

We we've got our um finance teams uh reaching out to both the CAO and the auditor to see what's possible, and so we just don't have that uh precise language buttoned up yet.

But will you have it buttoned up by next week?

We would like to have that there so that you know what would be.

Because I want to give them a sense of certainty, yeah.

Okay, because we might approve it, but then they might not get the money until September, and that's not gonna work.

Yeah, okay.

Are you are you just a second?

Are you okay with that, Supervisor Tam?

Yes, all right, go ahead, Vanessa.

If I can speak to that actually, so as of May the 19th, yes, the goal would be then to have written forward direction, provider, the full list of providers and the source of the funding and a plan.

However, we can also work with our or in addition, we will work with our finance team to what you were just discussing to identify a plan.

Once there it's finalized, it's approved.

We do have a plan so that between May and then July 1st there is no stoppage.

We can really move that forward so we can work with our finance team to just make sure we can hold them over.

We can manage that so we can work with our director and and just have a plan for that.

I think that's the intention.

I'm comfortable with that.

Uh Supervisor Tim, okay, and the agency director, okay.

All right.

So let's call call the role on the motion.

Supervisor Tam.

Aye.

Supervisor Miley.

Aye.

Motion passed.

Okay.

So I want to thank everyone for your patience, your advocacy, your concern, et cetera, et cetera, around this.

Let's see if we have any public speakers on non-agendized items today.

For the health committee.

There are no public comments on non-agendized items.

Okay, and I also want to thank Supervisor Tam because we wouldn't have been able to go this long had the PAL committee had wasn't canceled.

And also there was a joint meeting scheduled too after the PAL committee.

So Supervisor Tam actually had three committees today, back to back.

So she only ended up with this one.

So thank you.

So we are adjourned.