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County officials warn of risks, narrower eligibility in new Behavioral Health Services Act plan
Summary
Behavioral Health Director Natalie Boland briefed the board on the county’s draft BHSA integrated plan, highlighting narrower eligibility (Medi‑Cal beneficiaries with serious mental illness), new funding buckets including a housing intervention, increased state reporting and administrative set-asides, and potential cost and service risks if managed care plans do not cover mild-to-moderate needs.
Tulare County Behavioral Health staff opened a 30-day public comment period April 7 on their draft Behavioral Health Services Act (BHSA) integrated plan and warned supervisors about several major policy and fiscal shifts under the state program.
"BHSA eligible" will be a narrower classification than the county’s prior MHSA front door, Behavioral Health Director Natalie Boland told the board: "These are reserved for our Medi-Cal beneficiaries that have a severe behavioral health condition and a significant functional impairment." Boland said that mild-to-moderate needs are expected to shift to managed-care plans, while the county will focus on specialty care and crisis services.
Boland listed three required funding buckets under BHSA (full-service partnerships, clinical behavioral health services and a new housing intervention). She said the county already works with more than 52 housing sites and estimated the system has "over 750 beds available." She warned the county’s housing intervention bucket is near capacity because of prior housing investments and that BHSA rules limit how funds can be spent.
Board members raised carryover risks if managed care networks do not deliver mild-to-moderate care. "There's a big risk here that if the health plans don't step up and do their part of the new system we're going to end up having increased patient load in the severe treatment category," Dr. Britt said during questioning of staff.
Boland also said the state has increased its administrative set-aside (from what had been a 5% administrative take to 10% overall in the BHSA construct) and that county staff estimated the change represents several million dollars that would otherwise flow to local programs. The director stressed BHSA requires new statewide outcome reporting and the county may face corrective action if network adequacy and outcomes standards are not met.
County staff submitted the draft integrated plan to the California Department of Health Care Services and will file a final plan by the June 30 deadline after a local comment period. Supervisors and staff signaled concern about housing capacity, workforce transitions, and the county’s potential exposure for crisis-service costs if state reimbursement terms change.
