Expand All | Collapse All

• What is the Behavioral Health Transformation?
  • The State of California is leading an effort to modernize behavioral health, improve accountability, increase transparency, and expand the capacity of behavioral health care facilities. This effort is known as the Behavioral Health Transformation. This effort will implement Prop 1 which includes the Behavioral Health Services Act and the Behavioral Health Bond Act.
  • Behavioral Health Transformation complements and builds on California's other major behavioral health initiatives including, but not limited to:
    • California Advancing and Innovating Medi-Cal (CalAIM) initiative 
    • California Behavioral Health Community-Based Organization Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration proposal
    • Children and Youth Behavioral Health Initiative (CYBHI)
    • Medi-Cal Mobile Crisis
    • 988 expansion
    • Behavioral Health Continuum Infrastructure Program (BHCIP)
  • For more information, visit the Department of Health Care Services webpage.
• What is BHSA?
  • In March 2024, California voters passed Proposition 1, a two-bill package, to modernize the state’s behavioral health care system. One component of this is the Behavioral Health Services Act (BHSA), which updates the 2004 Mental Health Services Act. BHSA updates funding to support those with the greatest needs, expands the behavioral health workforce to better serve California’s diverse communities, and prioritizes outcomes, accountability, and equity.
• When does BHSA take effect?
  • New BHSA requirements will be fully implemented by July 1, 2026. However, planning and coordination to prepare for the shift to BHSA is ongoing, including the Community Planning Process to develop the BHSA Three-Year Integrated Plan which officially began in January 2025.
• What changes will be implemented?
  • Updates allocations for local services and state-directed funding categories.
  • Broadens the target population to include individuals with substance use disorder.
  • Focuses on the most vulnerable and at-risk groups, including children and youth.
  • Advances community-defined practices (community-based practices that have reached a strong level of support within specific communities) as a key strategy for reducing health disparities and increasing community representation.
  • Revises county processes and improves transparency and accountability.
• How are the components changing from MHSA to BHSA?
  • MHSA funding included five components: Community Services and Supports, Prevention and Early Intervention, Innovation, Capital Facilities and Technology Needs, and Workforce Education and Training.
  • BHSA has three funding categories and each has a required percentage allotment of funding: Behavioral Health Services and Supports (35%), Full-Service Partnerships (35%), and Housing Interventions (30%).
  • Under BHSA, population-based prevention moves under State management, as well as a statewide workforce initiative. The State’s allocation increases to 10% from the previous 5% and this will include: 3% for administration, 3% for the statewide workforce initiative, and 4% for population-based prevention.

Expand All | Collapse All

• Will contracted services change as the County implements BHSA?
  • Behavioral Health Services is comprehensively assessing the service continuum, including programs funded through other funding sources to align the entire system of care with State priorities under Behavioral Health Transformation, including BHSA.
  • The service assessment focuses on revenue sustainability and ensuring we are funding core programs that align with our statutory requirements as a specialty behavioral health plan. 
• When will contracted service providers know if their contract will sunset in the transition from MHSA to BHSA?
  • Notifications are being sent to contracted providers on a rolling basis beginning in October 2025 leading up to the July 1, 2026 BHSA implementation. BHS aims to provide as much notice as possible regarding the sunset of any contracts regardless of which MHSA component it falls within.

Expand All | Collapse All

• What types of activities will be conducted as stakeholder engagement?
  • Stakeholder engagement involves gathering input from providers, local partners, and residents with unique perspectives across San Diego County through various engagement activities such as listening sessions, focus groups, key informant interviews, workgroups and committees, community trainings, education and outreach, and more. 
• What focus areas will stakeholders be involved in?
  • BHSA requires counties to involve stakeholders in discussions around mental health and substance use disorder policy, program planning and implementation, monitoring, workforce, quality improvement, health equity, evaluation, and budget allocation.
  • In addition, based on learning from previous engagement efforts, Behavioral Health Services is expanding opportunities to discuss specific topics including accessibility, care coordination and navigation, community outreach and education, crisis response services, culturally appropriate and affirming care, support for people experiencing homelessness, services for youth and transition age youth, and workforce capacity and diversity.
• Will the 30-day Public Comment Period change?
  • No. Under BHSA, counties are still required to provide a 30-day minimum public comment period for their Integrated Plans or Annual Updates. Counties will also continue to conduct Public Hearings on the draft of Integrated Plans or Annual Updates at the close of 30-day public comment periods.

Expand All | Collapse All

• What happened to Prevention and Early Intervention funding?
  • Under BHSA, Prevention funding and services will shift to the California Department of Public Health (CDPH) using a portion of the State’s 10% BHSA allocation. CDPH will use the funding to implement population-based behavioral health prevention strategies.
  • Early intervention services may continue to be funded at the local level through the Behavioral Health Services and Supports (BHSS) component, if they align with BHSA requirements and priorities.
• How will the State CDPH use BHSA Prevention funds?
  • A minimum of 4% of BHSA funds will be directed to CDPH for population-based mental health and substance use disorder (SUD) prevention programs.
  • CDPH has completed community feedback gathering for the Phase 1 and Phase 2 BHSA Population-Based Prevention Program Guides. When finalized these guides will comprise the CDPH final plan that will guide implementation of the BHSA Statewide Population-Based Prevention Program for fiscal years 2026–29. 
  • The final plan from CDPH is currently pending but based on the Phase 2 Guide, CDPH has proposed the following: 
    • Have funding available to mobilize local reach of statewide strategies and policy in the form of grants for CBOs and Tribes.
    • Support statewide policy initiatives on emerging behavioral health issues. 
    • Establish statewide prevention strategies that leverage existing plans and initiatives.
    • Leverage existing public awareness campaigns (e.g., Never a Bother) and develop new ones on suicide and self-harm, 988 and crisis services, and substance use disorder prevention. 
    • Provide training and technical assistance in specialized areas. 
  • To learn more about the Population-Based Prevention Program and to view the Phase 1 and 2 guides, visit the CDPH website.
• How will the County use Early Intervention funds?
  • BHSA Early Intervention focuses on proactive approaches to identify and address behavioral health conditions early on to prevent them from getting worse. This category includes services for individuals experiencing a behavioral health crisis, mental health and substance use treatment services, and evidence-based practices for individuals experiencing a first-episode of psychosis.
• What are the requirements and goals of county-level Early Intervention programs under BHSA?
  • Counties must offer Early Intervention programs under the Behavioral Health Services and Supports (BHSS) category.
    • 51% of BHSS funds will be dedicated to early intervention programs. These services may include targeted outreach, screenings, access and linkage, and treatment services for individuals of all ages. 
    • Of those BHSS early intervention funds, 51% will be dedicated to children, youth and young adults 25 and under.
  • The goal of County Early Intervention programs is to stop mental health conditions and substance use disorders from becoming severe and disabling and reduce behavioral health disparities. These programs identify and address behavioral health concerns early, to reduce adverse outcomes in alignment with State behavioral health goals, which include: 
    • Suicide and self-harm
    • Incarceration
    • School Failure or disciplinary actions
    • Unemployment
    • Prolonged suffering
    • Homelessness
    • Family Separation
    • Overdose
    • Mental illness in children and youth 
• How is Early Intervention under BHSA different from Prevention and Early Intervention under MHSA?
  • Under BHSA, population-based prevention services previously funded under Prevention and Early Intervention (PEI) are now managed at the State level. Early Intervention services administered by the County are now more focused on providing evidence-based services that are sustainable and integrated with intensive treatment services as part of a comprehensive continuum that aligns with State requirements and priority populations. BHS will continue administering substance use prevention services, as these have dedicated funding through Substance Use Block Grants (SUBG). 

Expand All | Collapse All

• Are there any exemptions to BHSA mandates available to Counties?
  • All counties may request to transfer of up to 7% of funds out of any one component into another. A maximum of 14% of funds can be transferred between components. Any transfer requests must be approved by the County Administrative Officer and submitted to DHCS for approval by March 31, 2025. 
  • Small counties (population under 200,000) are eligible for a number of exemptions that do not apply to San Diego County (population 3.3 million).
  • There are some exemptions available to large counties. 
    • For the first Integrated Plan covering fiscal years 2026-29, all counties, regardless of their size, are exempt from the EBP fidelity requirements for ACT, FACT, IPS Model of Supported Employment, and HFW. Counties do not need to request this exemption in their first Integrated Plan. 
    • Beginning with the 2032-35 IP, larger counties may request exemptions from one or more of the following Housing requirements, if looking to transfer more than the allowable 7%:
      • 30 percent of the BHSF funds distributed to the county for Housing Interventions services.
      • 50 percent of the county’s Housing Interventions funds on those who are chronically homeless.
      • No more than 25 percent of Housing Interventions funds on capital development projects. 
  • Further details on requirements for transfers and exemptions can be found in the DHCS BHSA County Policy Manual.