DATE: June 10, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Fresno County Mental Health Services Act Annual Update 2025-2026
RECOMMENDED ACTION(S):
TITLE
Approve the Fresno County Mental Health Services Act Annual Update 2025-2026 and submit it to the California Department of Health Care Services and the California Mental Health Services Oversight and Accountability Commission.
REPORT
Approval of the recommended action will allow the Department of Behavioral Health to submit the Fresno County Mental Health Services Act (MHSA) Annual Update 2025-2026 to the California Department of Health Care Services (DHCS) and the California Mental Health Services Oversight and Accountability Commission (MHSOAC) by June 30, 2025. The MHSA Annual Update is required per Welfare & Institutions Code (W&IC), section 5847. The section describes the Annual Update process, whereby the County outlines the MHSA-funded programs and services according to community stakeholder input and the Community Program Planning Process (CPPP), per Title 9, California Code of Regulations (CCR), sections (§§) 3300 and 3200.060. The programs and services are provided to behavioral health persons served, 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 MHSA Annual Update; however, this action would prevent the County from having any spending authority related to its MHSA funds in FY 2025-2026 and all MHSA-funded services would halt until an Annual Update is approved. This would result in failure to adhere to the required statutes. Additionally, non-approval may place some MHSA 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 stakeholder process and submit the changes for 30-day public comment, further delaying the submission of the required plan.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. MHSA funding allows for full reimbursement of direct and indirect program and service costs. The projected funds for the Annual Update were included in the previously approved FYs 2023-2026 Three-Year Plan. The Board approved the three-year plan on June 30, 2023. The recommended Annual Update updates the projected budgets as follows:
FYs 2023-2024 through 2025-2026
FY 2023-2024: $ 106,615,403
FY 2024-2025: $ 85,582,420
FY 2025-2026: $ 85,582,420
TOTAL $277,780,243
DISCUSSION:
The Department is required to submit a new Three-Year Plan every three years and annual updates yearly for approval by the governing body, your Board, before submission to DHCS. In between the Three-Year Plan, counties shall develop and obtain approval for Annual Plan Updates.
The proposed Annual Update was completed with opportunity for input from the community. Counties are required to develop their plans through a CPPP (Title 9, CCR, §§ 3200.060 and 3300) which includes stakeholder engagement.
On February 26, 2025, the department facilitated an in-person community planning session for the MHSA Annual Update FY 2024-2025 with Spanish and Hmong interpretation. The Department also hosted a virtual community forum livestreamed on Facebook and YouTube to allow additional opportunity to participate and recorded that session on February 27, 2025.
The Department’s current MHSA Three-Year Plan was developed to focus on sustainability of services and the implementation of the California Advancing and Innovating Medi-Cal (CalAIM). The recommended Annual Update supports that commitment. Significant changes to MHSA via Proposition 1’s Behavioral Health Services Act, and pending regulatory updates limited significant changes to this current Annual Plan Update, pending more direction from DHCS. In the coming year the Department will have to develop a new integrated systemwide Three-Year plan as part of the new BHSA. In that plan the Department hopes to be able to use new guidance in the development of that plan.
The Department will continue to engage in improvement activities, including program evaluations to ensure the continued provision of high-quality and outcomes-driven services to residents of the County in a coordinated manner.
This Annual Update does not take any action related to Proposition 1. The Department posted the draft of this Annual Update for 30-day Public Comment period from March 17, 2025, through April 15, 2025. A Public Hearing was held on April 16, 2025, and the Annual Update was presented to the Behavioral Health Board to move to support the plan. The Department has complied with all statutory requirements for this Annual Update, and the components of Proposition 1 are not material to this update.
OTHER REVIEWING AGENCIES:
On April 16, 2025, the Behavioral Health Board held a public hearing. On the same date, the Behavioral Health Board voted unanimously to support the Fresno County MHSA Annual Update 2025-2026 and recommended 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 - MHSA Annual Update 2025-2026
CAO ANALYST:
Ronald Alexander Jr.