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Health Services director flags steep behavioral‑health funding shifts, Measure O constraints and service risks
Summary
Sonoma County Health Services staff presented a $545 million total budget plan that relies heavily on state and federal funding and warned supervisors the statewide shift from MHSA to the Behavioral Health Services Act could shrink behavioral‑health funding while reallocating a portion to housing.
Sonoma County’s new Health Services director, Nolan Sullivan, used his first budget workshop presentation to lay out a complex operating picture: behavioral health is the department’s largest cost driver, state and federal funding provide more than 40% of the agency’s revenue, Measure O currently funds dozens of local positions and programs, and major state policy changes and uncertain federal priorities could produce substantial short‑term revenue shifts.
Sullivan told supervisors Health Services’ operating expenditures were about $346 million in the department’s internal operating account, and the department’s total budget (including transfers and reimbursements) is roughly $545 million. Behavioral health accounts for more than half of the department’s operating budget and is growing fastest because of demand for mental‑health and substance‑use services.
Key policy and funding concerns - Prop 1 conversion (MHSA → Behavioral Health Services Act, BHSA): Sullivan said the statewide conversion will reduce behavioral health funding available for county services by an estimated 35% in a single year, while moving roughly 30% of those funds toward housing. Sullivan described the transition as likely to produce winners and losers and urged the board that many behavioral‑health contractors and county programs could be affected. - Realignment and fund balances: the department reported multiple realignment funds used to support public health and behavioral health; Sullivan said 1991 realignment appeared relatively stable for public health while the 1991 and 2011 realignment tranches that support behavioral health were trending down and projected to decline materially over the next fiscal year. Sullivan called those declines a structural risk. - Measure O: Sullivan reviewed Measure O balances and cautioned that quarter‑to‑date data revise an initially reported $47 million end‑of‑year balance down toward about $32 million. He also noted the budget figures did not yet include a forthcoming NOFA for homeless services nor expected city funding requests for mobile crisis teams, both likely to draw on Measure O reserves.
Mobile crisis and cities Sullivan said Sonoma County has many different mobile crisis arrangements across cities and unincorporated areas, producing variable service levels depending on where a response is requested. He said staff intended to stabilize and align funding for mobile crisis teams, maximize medical billing and standardize performance metrics, and that the county will likely seek to fully fund requests in the near term while negotiating more standardized contracts to improve data and billing.
Program change requests and facilities Sullivan described three Program Change Requests he planned to submit in this budget round: - A state‑funded licensed behavioral‑health clinician supported by a Department of State Hospitals grant. - Animal‑services staffing increases (1 animal tech, 1 animal control officer, 0.5 FTE clerk) and a major animal‑services facility improvement and expansion request, initially estimated at about $8 million though staff warned construction costs could increase the final figure.
Why it matters: Health Services is one of the county’s top three budgets and funds critical safety‑net programs. The department’s exposure to state and federal policy changes — and to the MHSA→BHSA conversion in particular — creates near‑term uncertainty for contracts, provider partners and county staff who deliver behavioral‑health services.
What officials asked for: Supervisors pressed Sullivan for five‑year revenue projections, clearer Measure O accounting and a plan for mobile crisis funding and contracting that would reduce variability across cities.
Where it goes next: Sullivan said he and his team will return with more granular fund‑balance and program‑level options; he urged the board to prioritize continuations of existing services while staff design more standardized contracting and billing to increase sustainability.
