By Susan Meeker
With California’s Proposition 1 on the March 5 ballot likely to eke out a narrow victory, Colusa County officials have begun measuring the fiscal impact the governor-backed measure will have on mental health services and substance abuse treatment for people in the local community.
Behavioral Health Director Tony Hobson, at the Board of Supervisors March 12 meeting, said the state’s mental health reforms, unfunded mandates, and regulatory changes could have a significant effect on the department’s budget, now that a mobile team of mental health crisis service providers must be available 24 hours per day, seven days per week, for all persons, with or without state-funded Medi-Cal or insurance.
Hobson said Behavioral Health currently only responds to individuals in mental health crises who come into the jail or hospital.
“So, if we come across somebody in the community who has private pay, we resolve the crisis, hopefully, or hospitalize and we have to try to get reimbursement from the private plans, which is not likely,” Hobson said. “So, we absorb that cost.”
Although Proposition 1, which appears to be passing by a small margin, approves a new $6.4-billion bond to build more places for mental health care and drug or alcohol treatment and more housing for people experiencing homelessness, the state plans to bridge the $7 billion funding gap by reconfiguring the 20-year-old “millionaire” tax for mental health services.
Under Prop. 1, the State will receive 10% of the money raised by this tax, up from 5%. Counties will receive 90%, down from 95%, while being required to spend more of their MHSA money on housing and personalized support services, such as employment services and education, officials said.
On the positive side, Hobson said Behavior Health may be able to avert overall costs by being able to assist people in crisis in their homes before they are hospitalized.
“That’s the good side of this,” he said. “The downside is that we have to create a plan, hire staff, and we don’t know what we are going to get paid yet. The state has not given us our rate. So, we don’t know what it’s going to cost us. We projected just over $1 million to do this extra benefit.”
As for Prop 1’s requirement for the county to spend 30% of his MHSA funding to house the homeless, Hobson hopes the county can get an exemption from the state.
“We can’t spend that much…” said Hobson, noting the county currently spends just 2% percent on housing. “For us to have housing and dedicate 30% to housing will pretty much destroy most of our service delivery in this county.”
Hobson said Colusa County cannot apply for the exemption until January 2025.
“If we don’t get it, I’ll be up here this time next year painting a whole different picture,” he said.
Jeanie Armstrong, Program Manager of Clinical Services, said if Prop 1 passes, Colusa County will develop a Behavior Health Services Plan like the county’s MHSA plan, which, if approved by the Board of Supervisors, will be implemented in 2026-27.
If the county receives the housing exemption (anticipated for counties with less than 200,000 in population), the 30 percent housing element of Proposition 1 could be spent on other behavioral health programs, such as community services and support for individuals at-risk for hospitalization or incarceration, early intervention, and temporary housing, Armstong said.
Bonnie Briscoe, Deputy Director of Behavioral Services Fiscal Administration, said in addition to the automatic reduction of 5% in revenue taken by the state to implement Proposition 1, Colusa County anticipates an increase in new administrative costs to be about 4%, for a total loss of about $250,000.
The new state mental health reform laws, including the mandatory increase in health care workers minimum wage and SB 43, could also have a profound effect on the county’s ability to open
Cypress House in Williams, a facility the county has been working on for four years to provide local housing and care to Colusa County individuals under conservatorship for mental health disorders.
Colusa County Chief Executive Officer Wendy Tyler said the facility, which was well intentioned when the county started this process, may now become a detriment to the county and its citizens due to the changes in state law.
SB 43, which Newsom signed into law in October, expanded the definition for those eligible for conservatorship to include people who are unable to provide for their personal safety or necessary medical care, in addition to food, clothing, or shelter, due to chronic substance use and not just serious mental health illnesses.
County officials said they no longer see the nine-bed facility breaking even, and that they may, in the next 18 months, decide on another use for the building.
Supervisor Kent Boes said he has long been a champion for a westside campus for Health and Human Services/Behavioral Health and believes that not opening the facility may allow the county to pivot to a use that serves more Colusa County citizens overall.
The Board of Supervisors will make a final decision on Cypress House or pivot to another use for the facility after it comes back for more in-depth discussion later.
Meanwhile, the California Secretary of State has until April 12 to certify the March 5 election results.
Although Newsom boasted Proposition 1 would be an overwhelming victory for his agenda to combat homelessness and substance abuse, the measure is likely to pass with only 2% favorability over the opposition, due to the significant cost to taxpayers and the impact on local services provided by counties.