DATE: June 16, 2026
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Fresno County Behavioral Health Services Act Integrated Plan 2026-2029
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute the Fresno County Behavioral Health Services Act Integrated Plan 2026-2029, which will be submitted to the California Department of Health Care Services and the California Behavioral Health Services Oversight and Accountability Commission; and
2. Approve and authorize the Department of Behavioral Health Director, or designee, to revise the Integrated Plan 2026-2029 when required by the California Department of Health Care Services, without substantive changes to budget or programming, and provide a summary of all changes subsequently to the Board.
REPORT
Approval of the recommended actions will allow the Department of Behavioral Health to adopt a new three-year plan necessary to render services funded through the Behavioral Health Services Act (BHSA) and to submit the Fresno County BHSA Integrated Plan 2026-2029 to the California Department of Health Care Services (DHCS) and the California Behavioral Health Services Oversight and Accountability Commission (CBH) by June 30, 2026. The BHSA Three-Year Plan is required per Welfare & Institutions Code (W&IC) section 5963, which describes the requirements for the three-year program and expenditure plan, whereby the County outlines the programs and services provided within the public behavioral health system. The programs and services are provided to persons served needing behavioral health services, their family members and target populations throughout the County, with no increase to Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
Your Board may choose not to approve the BHSA Integrated Plan; however, this action would prevent the County from having any spending authority related to its BHSA funds in FY 2026-27 and all BHSA-funded services would halt until a new Integrated Plan is approved. This would result in failure to adhere to the required statutes and subject Fresno County to potential sanctions. Additionally, non-approval may place BHSA funds at risk of reversion to DHCS as the funds are subject to expenditure time limits. Further, if your Board recommends significant changes to the plan, the Department will be required to re-engage the community through a new stakeholder process and submit the changes for DHCS review and 30-day public comment, further delaying the submission of the plan.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. BHSA funding allows for full reimbursement of direct and indirect program and service costs and allows the county to use BHSA as a match for other state and federal funding. This Integrated Plan projects expenditures for the next three fiscal years for all Behavioral Health funding sources; however, these projections may change. Any changes will be described in future Annual Updates. The recommended Integrated Plan describes the projected BHSA budgets as follows:
FYs 2026-2027 through 2028-2029
FY 2026-2027: $105,235,966.00
FY 2027-2028: $112,394,013.00
FY 2028-2029: $ 114,691,793.00
TOTAL $332,321,772.00
DISCUSSION:
The Department is required to submit a new Integrated Plan every three years and annual updates yearly for approval by your Board, before submission to DHCS.
The proposed Integrated Plan was completed with the required input from the community. Counties are required to develop their plans through a Community Planning Process (W&IC 5963.03) that includes twenty-seven (27) required stakeholder groups.
The Department engaged all twenty-seven (27) stakeholder groups noted in the Behavioral Health Services Act during the Community Planning Process through public forums, surveys, and key informant interviews. In addition, the Department held a voluntary additional follow-up session on April 28, 2026, to assist the community in understanding the BHSA Integrated Plan. The plan was posted for a 30-day Public Comment period from April 7, 2026, through May 18, 2026. A Public Hearing was held on May 20, 2026.
The draft plan was provided to the County Administrative Officer for attestation of review prior to the required submission of drafts to DHCS. The CAO provided attestation of the review on March 26, 2026. The Department submitted the draft plan to DHCS on March 27, 2026, for initial review and received revision requests from DHCS on April 20, 2026. The Department provided the requested revisions to DHCS on May 5, 2026.
This BHSA Integrated Plan was developed to focus on meeting regulatory requirements, sustainability of services and the implementation of the California Advancing and Innovating Medi-Cal (CalAIM). The Department will continue to engage in improvement activities, including enhanced system oversight and monitoring necessary to evaluate new, mandatory outcome measures.
OTHER REVIEWING AGENCIES:
On May 20, 2026, the Behavioral Health Board conducted a public hearing for the BHSA Integrated Plan 2026-2029 and referred it for presentation to your Board for final approval.
REFERENCE MATERIAL:
BAI #49, June 20, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - BHSA Integrated Plan 2026-2029
On file with Clerk - Fresno County Integrated Plan Budget
CAO ANALYST:
Ronald Alexander Jr.