California Measure to Transform Behavioral Healthcare Passes by Slim Margin

March 22, 2024
Proposition 1 includes a nearly $6.4 billion bond to build 10,000 treatment units and supportive housing

A bond measure to transform California’s behavioral health system recently passed by a slim margin. Gov. Gavin Newsom and other supporters of the measure say that Proposition 1 evolves the Mental Health Services Act (MHSA) into the Behavioral Health Service Act (BHSA) and increases funding for housing interventions and workforce investments, continuing local flexibility to use resources to address local needs, and strengthening county oversight and fiscal accountability.

The margin of victory for the measure ended up being so close that it took the Associated Press 15 days after election day to determine that the measure had passed. 

As a California Health Care Foundation blog explains, the proposition includes a nearly $6.4 billion bond to build 10,000 treatment units and supportive housing. It also asked voters to redefine how counties spend money collected from a special “millionaire’s tax” to allocate a share of it for housing for people with behavioral health illnesses.

“This is the biggest reform of the California mental health system in decades and will finally equip partners to deliver the results all Californians need and deserve,” said Newsom in a statement. “Treatment centers will prioritize mental health and substance use support in the community like never before. Now, it’s time to roll up our sleeves and begin implementing this critical reform – working closely with city and county leaders to ensure we see results.”

Newsom and supporters have promoted Proposition 1 as a way to help address the state’s homelessness and addiction crises, the CHCF blog noted, adding that opponents of the ballot measure say diverting money in the Mental Health Services Act for housing will result in up to $1 billion in cuts to current mental health programs such as outpatient care and crisis response.

In a news release the California Department of Health Care Services said the behavioral health transformation will help improve accountability, increase transparency, and expand the capacity of behavioral health care facilities across California.

“This is a historic moment for Californians and our behavioral health care system," said DHCS Director Michelle Baass, in a statement. “The state is taking steps to ensure everyone has equitable access to the care they need, regardless of their background or location. This work brings greater transparency to behavioral health care, allowing Californians to see how their state and local governments are working to ensure people can thrive in their communities.”

“Housing is the most basic foundation every human being needs to achieve and maintain stability in life," said California Department of Housing and Community Development Director Gustavo Velasquez, in a statement. “This is especially true for people with mental health challenges who need regular, consistent access to health care providers or counselors. The passage of Proposition 1 will allow California to expand on the successes achieved by programs like Homekey that give our most vulnerable residents that foundation, directly connected to the critical supportive services that can help us make homelessness rare, short-lived, and non-recurring."

DHCS will now begin developing policy and guidance to support counties in fulfilling the statutory requirements in the initiative. Guidance will be released in phases to allow counties adequate time to leverage the policy for local administration. DHCS aims to bring behavioral health funding streams into alignment and break down silos to improve the delivery of services to Californians who need this life-saving behavioral health care. There will be opportunities for stakeholder engagement throughout the policy development process to guide the most effective use of this vital funding. 

The Behavioral Health Continuum Infrastructure Program (BHCIP) will be the program to distribute the roughly $4 billion in bond funds for which DHCS is responsible.

DHCS notes that these programs and proposals complement California's other major behavioral health initiatives, including the California Advancing and Innovating Medi-Cal (CalAIM) initiative, California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration proposal, Children and Youth Behavioral Health Initiative (CYBHI), Medi-Cal Mobile Crisis and 988 expansion, and Behavioral Health Continuum Infrastructure Program (BHCIP). 


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