State shifts prevention to CDPH under Prop 1; counties and community programs warn of lost locally led services

The Commission for Behavioral Health on Day 2 of its January meeting held a panel on population‑based prevention under the Behavioral Health Services Act (BHSA), where public health officials, managed‑care representatives and county and community providers warned that the shift from county‑run Prevention and Early Intervention (PEI) work to a statewide model risks disrupting locally driven programs.

Trudy Raimondo of the California Department of Public Health, who is helping lead the BHSA prevention effort at CDPH, described the agency’s approach as statewide and data‑driven. “When we talk about population‑based prevention, we’re thinking about the entire state, the entire population or subsets of the population,” Raimondo said, framing CDPH’s role as coordinating promotion, universal and selective prevention and building shared metrics and technical assistance.

County officials and community advocates said that framing and funding rules in recent state guidance are already producing uncertainty at the local level. Michelle Cabrera of the County Behavioral Health Directors Association summarized the change from the 20‑year MHSA model: counties previously administered PEI programs locally; under BHSA a share of revenue is moved to state administration and counties must now follow new early‑intervention definitions. Cabrera noted the fiscal effect: “It’s roughly $120,000,000 that CDPH will be responsible for,” and said counties face a new housing set‑aside and narrower allowable uses for local funds.

Community providers and advocates said the transition threatens culturally defined, grassroots prevention work that targeted historically underserved communities. Stacy Hiramoto of the Racial and Ethnic Mental Health Disparities Coalition warned that many CDEPs were designed as nonclinical prevention and may not fit the new early‑intervention categories. In public comment, Hazmeen of The Children’s Partnership cautioned that “some counties believe they have received a directive from the state to eliminate prevention entirely,” urging clearer state instructions so effective local programs can be adapted rather than dismantled.

Managed‑care plans described existing prevention practice that will need to connect with the new statewide approach. Carmen Katzroff of CalOptima Health said plans use population health management, member outreach, risk stratification and case management to identify and serve higher‑risk beneficiaries and to fund non‑specialty mental health care — services she described as part of the broader prevention ecosystem that must be coordinated with CDPH and counties.

Panelists recommended immediate steps to reduce disruption: clearer, consistent guidance on allowable activities and funding; investing in evaluation and shared data systems; targeted transitional funding for community organizations and peer‑run programs; and active partnership among CDPH, DHCS, counties, managed‑care plans and community organizations. Several speakers urged the commission to use its convening and advisory role to press for clarity and to monitor county planning processes so that the BHSA’s stated prevention goals do not come at the expense of community‑driven, culturally specific programs.

The commission said it will continue oversight and discussion of BHSA implementation in upcoming meetings and invited the panel back for a follow‑up session.