mental health association of san francisco what’s up in california: new funding sources for mental...

Mental Health Association of San Francisco

What’s Up in California: New Funding Sources for Mental Health Services

National Alliance to End HomelessnessAnnual Conference

July 18, 2006

Presentation by:Alecia Hopper Jonathan HunterPublic Policy Coordinator California Program

DirectorMental Health Association Corporation for Supportiveof San Francisco Housing

Moderated by: Karen Gruneisen, Managing Attorney, HomeBase


Focus on:Mental Health Services Act (Proposition 63)

Governor’s Initiative to End Chronic Homelessness


Part I:

Mental Health Services Act


History In California 1968: state mental hospitals emptied

California led the nation in deinstitutionalizing mental illness

Promise of community care Promise never fulfilled Currently, tens of thousands are without care

more than 50,000 individuals with severe mental illness live on the streets of California


Background Darrell Steinberg,Assemblyman, Sacramento

AB 34/AB2034 (1999) Created “integrated servicesmodel”

Importance of what was measured - cost savings


Why an Initiative? In spite of clearly documented offsetting savings, the Legislature has been unwilling to expand programs

Strong public support 36 year unfulfilled promise of community programs


This initiative is funded by... 1% tax on “taxable” personal incomes over $1 million Taxpayers earning $1.5 million would pay a tax of $5000

Deductible from federal income taxes

Is this tax fair? This tax is a small portion of what these taxpayers save

California Property Taxes and recent federal tax cuts


How does Prop. 63 affect the State Budget? Existing Entitlements are Protected State can’t reduce funding or shift costs to counties Funds must be used to expand not supplant services

Estimated $500 million savings for State General Fund in criminal justice system, emergency rooms and welfare LA County jail is the largest mental health care provider in California


What does Prop. 63 do? The Mental Health Services Act became law effective January 1, 2005

Provides almost 1 Billion per year to counties $1.1 and 1.2 billion for 05/06 Estimated between $1.2 and 1.3 billion for 06/07

Uses allocation formula Offers mental health care to children, transitional age youth, adults, seniors

Covers uninsured, and those whose insurance coverage has run out


MHSA Fund Allocation – FY 05/06-FY 07/08 Education/Training = 10%

Capital Facilities/Technology = 10%

State Imp/Adm. = 5%

Local Plan = 0%

Prevention/Early Intervention = 20%

CSS = 55%- (5% of Prev & CSS for “innovative programs”)

Ed&TrCap&TStateLocalPrev.CSS


Five Funding Areas 1) Prevention and Early Intervention

20% of funding This component will support the design of programs to prevent mental illnesses from becoming severe and disabling, with an emphasis on improving timely access to services for underserved populations.

Emphasis on reducing: Suicide Incarcerations School failures or dropouts Prolonged suffering Homelessness Removal of children from their homes


Five Funding Areas 2) Community Services and Support (CSS) 50% of funding The CSS are the programs, services, and strategies that are being identified by each county through its stakeholder process to serve unserved and underserved populations, with an emphasis on eliminating racial disparity.

At least 51% of $ must be spent on wrap-around “whatever it takes services”

based on AB34 program (see http://www.ab34.org/) The remaining $ are spent as determined by the County based on an intensive public stakeholder process


Five Funding Areas 3) Education and Training 10% of Funding This component will target workforce development

programs to remedy the shortage of qualified individuals to provide services to address severe mental illnesses.

State will create plan Educational stipends, loan forgiveness and other strategies to increase the mental health workforce


Five Funding Areas 4) Capital and Information Technology 10% of funding This component will address the capital infrastructure needed to support implementation of the Community Services and Supports programs.

It includes funding to improve or replace existing IT systems and for capital projects to meet program infrastructure needs.


Five Funding Areas

5) Innovative Programs 5% of the funding The goal of this component is to develop and implement promising and proven practices designed to increase access to services by underserved groups, increase the quality of services and improve outcomes, and to promote interagency collaboration.


MHSA Fund Allocation – Years 5+ State Imp/Adm. = 5%

Prevention and Early Intervention* = 20%

CSS = 75%- (5% of Prev. & CSS for “innovative programs”)

Local Planning up to 5% of local funds

NOTE: Capital Facilities is no longer a “set aside” but counties can choose to devote CSS funds to meet capital needs on an ongoing basis!

Maximum of 20% can be dedicated to Capital / IT, Education and Training (ie Human Resources) and Prudent Reserve

StatePrev.CSS

*Amount for Prevention and EarlyIntervention can be increased in specific circumstances.


Stakeholder Process Stakeholder: a person or an organization that feels they have an active interest in the outcome of an issue or topic. clients, family members, county mental health departments, mental health providers, schools, social services, law enforcement and others.

Intensive on going local and state-wide stakeholder process In San Francisco over 70 community meetings held to create CSS plan

State DMH holds on-going meetings, conference calls, email updates, etc.


Oversight and Accountability Commission

Responsible for Oversight of the MHSA 16 members-- All appointed by governor

Attorney General Superintendent of Public Instruction Chairperson of the Senate Health and Human Services Committee Chairperson of the Assembly Health Committee Two persons with a severe mental illness a family member of an adult or senior with a severe mental illness a family member of a child who has or has had a severe mental

illness a physician specializing in alcohol and drug treatment a mental health professional a county Sheriff a Superintendent of a school district a representative of

labor organization an employer with less than 500 employees an employer with more than 500 employees a health care services plan or insurer


Oversight and Accountability Commission

Law requires counties to develop three year plans

Plan must be developed with local stakeholders and receive state approval

Reviewed and renewed on a yearly basis

Works with State DMH to develop policies that will transform the mental health system in California


Reasons for Optimism Purpose is to transform the mental health system, not business as usual

Shifts the system from fail first to help first by focusing funds specifically on prevention and early intervention

Funds are continuously appropriated

Funds are not tied to “medical necessity” - local creativity results

Cultural competence in service delivery is fostered


More Reasons for Optimism Communities articulate the link between “recovery” and permanent housing and fund housing

Unprecedented consumer and family involvement brings much expertise

New roles emerging for seasoned stakeholders

Helps to reduce mental health stigma

Increases the political voice of the mental health community


Part II:

Governor’s Initiative to End Chronic Homelessness

(“GHI”)


GHI, Phase I: New Capital Dollars!! A New Funding Program was established by the

Governor in 2005 to target housing funds to projects serving people who are severely mentally ill and chronically homeless

Note: the State is NOT using the HUD definition of chronically homeless but individual projects may use the more restrictive HUD definition if they are leveraging HUD funds

This program funding is comprised of: $40 million in MHP (Multifamily Housing Program-Prop 46)

$2 million in MHSA (from State administrative dollars)


GHI, Phase I: More than Housing Fund In addition to this housing fund, the Governor: Created the State Interagency Council on Homelessness

Provided funds for the Council to develop a Ten Year Plan to End Chronic Homelessness;

Provided MHSA funds to provide training to counties on building collaboratives to develop supportive housing


GHI, Phase I: Application Process These housing funds are available by applying to the State Department of Housing and Community Development

The application form and process is similar to the State’s existing Multifamily Housing Program

The application process opened on January 16, 2006 and the deadline for submitting an application was July 14, 2006

A handful of applications received; application process revisited


GHI, Phase I: What is Funded At least 35% of the units in a project must serve the GHI target population to be eligible

The GHI program provides $30,000 per unit MORE in loan funds than MHP

GHI provides $5,000 per unit in MHSA funding in a lump sum to establish a rent reserve


GHI, Phase I: Funding Requirements MHSA funding for services is required, and must be committed, to submit an application

MHSA funding for operating subsidies is “expected,” unless there is a Federal source that will cover this cost

The GHI program requires the same sponsor experience criteria as MHP


Governor’s Initiative to End Chronic Homelessness: Phase II As part of the (2006) May Revise, the Governor has

announced Phase II of the Governor’s Chronic Homeless Initiative $75 million of MHSA funds per year will be “pooled”

at the State The goal is to leverage these pooled funds with other

public and private investments to create supportive housing for people with mental illness who are chronically homeless or coming out of institutions

The pooled funds will be administered by the California Housing Finance Agency (CalHFA)

State DMH, Housing and Community Development (HCD) and CalHFA will continue to be partners in expanding supportive housing options and leveraging funding opportunities


GHI, Phase II: What we Know Now “Chronic homeless” definition currently used in GHI is not the HUD definition. The definition to be used in Phase II will be worked out in conversation with stakeholders in the state’s Ten Year Plan process (probably this summer)

CalHFA is moving legislation to establish a special needs lending program that will be separate from its current lending instruments; the goal is flexibility to construct complex deals


GHI, Phase II: What we Know Now Projects receiving capital funds must be linked to MHSA services and operating support funded by the county

State will work in partnership with counties to determine allocation goals and process and to ensure small county set aside

Technical assistance will be available to counties and project sponsors


GHI, Phase II: What we Know Now The $75 million amount means that counties will still have “room” to designate local MHSA funds for other capital and workforce development needs

State will be working in partnership with counties to further define program and process

Flow of projects is anticipated to be developer/sponsor seeks county approval and partnership then goes to state DMH and CalHFA


GHI, Phase II: What we Know Now Some Goals include:

leverage bonds, tax credits and other existing instruments

link to existing Ten Year Plans to end homelessness and other partnerships

partner with other local investments by cities, counties, redevelopment authorities, etc.

real homes for real people integrated into the fabric of the community

13,000 units of housing over twenty years First funds may be available in early 2007


Questions?Alecia HopperMental Health Association of San Francisco

Phone: 415.421.2926Email: [email protected]

Jonathan HunterCorporation for Supportive Housing

Phone:619.232.3197Email:[email protected]

mental health association of san francisco what’s up in california: new funding sources for mental...

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