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Sonoma County officials say Measure O funds critical behavioral-health services but warn of funding cliff
Summary
County health officials told the Board that Measure O has funded hospitals, crisis response and school-based interventions serving thousands, but the fund balance is shrinking and proposed state changes to Medi-Cal reimbursements could threaten mobile crisis operations.
County Health Director Nolan Sullivan told the Board of Supervisors on March 24 that Measure O has become the foundation for the county's most intensive behavioral-health services but that the program faces budget strain and policy risk. "Measure O is pumping about $55,000,000 back into Sonoma County to fund our critical behavioral health safety net," Sullivan said, adding that roughly $33 million was direct Measure O spending last year and that the county leveraged an additional $20 million in federal funds.
Sullivan outlined how the measure's revenue is distributed under the ballot's expenditure categories and said the largest single category now is emergency and psychiatric services, which consumed about $30 million in the last fiscal year. He said Measure O paid for 208 psychiatric placements and 328 residential care placements, and supported crisis-stabilization beds, step-down residential care and mobile crisis programs.
The presentation included a detailed fund-balance review: the county began with a large fund balance in early years while programs ramped up, but Sullivan said the balance is being spent down rapidly. He estimated the Measure O reserve will fall from about $35 million to roughly $10 million by the end of fiscal 2026–27 and projected that the measure could exhaust its balance by the time the tax expires unless revenues or program priorities change.
A central financial risk, Sullivan said, is a proposed change in the state budget that would make the mobile-crisis Medi-Cal benefit optional rather than mandatory, potentially cutting reimbursements that counties use to cover clinical mobile responses. "If the governor keeps that change in the budget it will most likely kill mobile crisis across the county," Sullivan said, citing per-incident Medi-Cal rates that can exceed thousands of dollars.
Supervisors pressed Sullivan on options if state support is reduced. Sullivan and staff said the county could scale back coverage to peak hours, consolidate teams or redirect Measure O dollars, but any such changes would reduce response levels and geographic coverage. Several supervisors and members of the public urged more consistent messaging about how Measure O funds are used and suggested the Board prepare a clear public-information campaign ahead of any renewal vote.
Sullivan closed by noting the department had reduced internal billing backlogs and that the Measure O Oversight Committee reviews all expenditures; he said staff are preparing materials for community briefings and planning for a possible renewal campaign. The Board directed staff to return with additional options and cost estimates for maintaining critical programs under varying revenue scenarios.
