Alameda County warns of major funding shift as MHSA gives way to BHSA; providers urge preservation of prevention programs

Alameda County behavioral‑health leaders told the Health Committee on June 9 that the county is approaching a complex, time‑sensitive transition from the Mental Health Services Act (MHSA) to the Behavioral Health Services Act (BHSA), and that updated state revenue estimates will reduce the county’s planning flexibility for FY25–26 and the BHSA launch.

Dr. Karen Tribble, Behavioral Health Director, opened the committee’s MHSA update by warning of a substantial fiscal shift: the department’s draft FY25–26 MHSA annual plan lists a budget of $220,000,000, but state revenue estimates released after the plan were prepared indicate a roughly $40–42 million reduction in state allocations countywide and substantially smaller expected carryover. Tracy Hazleton, who presented budget technicals, said carryover/unspent funds held from prior years (about $124,000,000 in the slides) were expected to help soften the transition but that recent revenue revisions will meaningfully reduce available unspent dollars going into BHSA planning.

The county summarized key constraints and new BHSA requirements: BHSA divides county allocations into housing (30%), full service partnerships (35%), and behavioral health services and supports (35%); the latter component carries mandated elements such as a requirement that a substantial share target ages 0–25. The state will also require an integrated plan, expanded, near‑real‑time financial and outcomes reporting, and six required statewide performance measures plus one county‑selected goal. Staff warned some prevention and early‑intervention programs may not be able to convert to Medi‑Cal billable early‑intervention services and therefore could be at risk under the new structure.

Why it matters: County providers and community groups say prevention and culturally tailored PEI/UELP programs are lifelines for linguistically diverse and historically underserved populations; losing them could increase disparities and push more people into crisis care, emergency departments and inpatient settings.

Supervisor Meili and others asked staff where a hypothetical new set of funds would be focused; staff said prevention and treatment would be the priority, but noted statutory constraints and mandated minimums for housing and FSPs limit flexibility. Vanessa Baker, deputy director and plan administrator, said the draft plan had been posted for public comment and that staff will recommend the draft MHSA plan to the full board for approval as part of the statutory process.

Public commenters — more than 20 speakers from community‑based organizations and health centers — urged the board to preserve prevention/early intervention funding and to protect peer‑run and culturally specific programs that serve immigrant, refugee and limited‑English communities. Testimony included program directors from PEERS (Jennifer Vaneman), Asian Health Services leadership, Filipino Advocates for Justice, Pacific Center for Human Growth, African community groups, and others who described the services they provide, the populations they serve, and the operational risk they face if PEI/UELP funds are not maintained.

Several presenters warned that conversion to Medi‑Cal billing will exclude some populations (e.g., limited‑English or undocumented residents) and many community models rely on non‑billable activities such as outreach, community events, peer support and culturally based programming. Jennifer Vaneman of PEERS said those prevention programs "are life saving and life altering" for people experiencing homelessness, repeated hospitalizations or incarceration. Tracy Hazleton and Dr. Tribble acknowledged that not all PEI programs will be billable and said the county is evaluating options to sustain promising programs where possible.

Next steps and staff direction: Staff asked the committee to recommend the draft MHSA annual plan for full‑board approval and to continue planning for a BHSA integrated plan, with a formal draft and public comment period targeted for spring 2026 and final plan submission by June 30, 2026 (statutory deadlines were cited). Staff committed to continued provider engagement, work on billing transitions, tracking federal and state guidance, and analyzing potential local funds (including Measure W and opioid‑settlement dollars) and flexibilities that could mitigate program losses. Supervisors requested further detail on triage options and cautioned against cutting community prevention that would increase downstream costs and disparities.