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Sonoma County doubles down on 24/7 mobile crisis response while racing to find sustainable funding
Summary
Health department officials told the Board of Supervisors Aug. 26 that Sonoma County has expanded countywide mobile crisis services and must maximize Medi‑Cal billing, unify data systems, and reduce duplication to sustain growth as Measure O and behavioral health funds decline.
Sonoma County officials on Aug. 26 told the Board of Supervisors that the county’s 24/7 mobile crisis teams have expanded rapidly but now face a sustainability problem that will require stronger revenue collection and operational consolidation.
DHS Director Nolan Sullivan said the county must “show us the money” by billing Medi‑Cal and aligning data across three separate response systems — the county Mobile Support Team (MST), SAFE (city-based teams), and Santa Rosa’s In Response program — to reduce duplication and stabilize costs. He said Medi‑Cal reimbursement could be significant if the county fully meets state requirements: “we can bill about $4,700 per instance,” Sullivan said, while noting the complexity of compliance and billing systems.
Why this matters: the county is legally required to offer a Medi‑Cal mobile crisis benefit to eligible recipients and the service has become a core emergency response for behavioral health. Officials said call volumes rose sharply after removing law‑enforcement barriers and establishing a unified call center, with a large share of calls now resolved without police involvement — a key public‑safety and public‑health goal.
What officials proposed: Sullivan and mobile crisis manager Wendy Tappan outlined three priorities: (1) maximize Medi‑Cal billing by getting partners certified and credentialed, (2) align metrics and client data in SmartCare so the county can compare performance across providers, and (3) reduce duplicated infrastructure (dispatch centers, vehicles) where possible to lower costs. Staff also reported an operational budget trend: MST now operates roughly 32.5 FTE on about a $7.5 million annual budget and the combined county‑partner investments have climbed steeply in recent years.
Community and city officials backed the direction. Mayor Judah Che and other city partners praised the SAFE team’s local work and urged continued county–city collaboration. Several supervisors acknowledged the program’s benefits but pressed staff on fiscal controls, revenue capture, and geographic equity so that all districts have consistent access to services.
Unresolved issues and next steps: DHS said partners must pursue Medi‑Cal site certification, SmartCare onboarding, and mandatory training to qualify for higher reimbursement rates. Staff recommended building multiyear MOUs contingent on partners achieving billing and data milestones. The board asked for more detailed financial forecasts, diversion metrics (especially emergency‑department diversions) and a countywide public outreach plan; staff said standardized reporting and a marketing push are planned over the coming year.
The presentation was informational; no formal board action was required on the day. The county continues to fund operations in part with Measure O and behavioral health realignment dollars while pursuing Medi‑Cal revenue and private insurer contributions.
