What is the problem that needs to be addressed? Please describe how it is related to mental health.
On February 27th, the California State Auditor released a report finding that the California Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission (MHSOAC) failed to provide adequate Mental Health Services Act (MHSA) oversight resulting in Counties accumulating excessive balances of MHSA funds that should have gone to provide mental health services. Orange County’s failure to use MHSA resources as they were intended has resulted in a $241,931,000 fund balance, the second largest in the State.
Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
Last fiscal year alone, the Orange County Health Care Agency (HCA) under-spent the MHSA budget by $51,744,226. These are resources that could have supported vitally needed mental health services in our County. Orange County and other counties can learn an alternative systemic approach to traditional RFP funding mechanisms to fund mental health services in a way that is more responsive to community needs and eliminates delays in implementation.
What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
Beyond the California State Auditor report, various pieces of legislation have been proposed to address the issue of MHSA underspending and financial transparency. However, these avenues do not address the underlying systemic issues in why it has been difficult to implement MHSA funding. This is because implementation and the issues associated with it, occur at the local level and arise out of a local mental health agency desire for utilizing a command and control approach.
What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
The MHSA Community Opportunities Fund concept is unique and does not occur in any other jurisdiction.
Other County Mental Health Agencies
What is the project idea? Please describe how this project will operate.
The MHSA Community Opportunities Funds (MHSA COF) provides a mechanism for the consideration of additional community-based programs and initiatives throughout the year that will be funded by otherwise unutilized budgeted amounts in the Plan. Through a Request for Applications (RFA) selection process, research driven proposals from community-based organizations, private providers and provider networks, and hospitals will be considered for funding mental health services. For the Innovation pilot, funding will be made through a MHSA Local Grant Administrating Agencies (LGAA) that will review and award proposals and provide compliance monitoring of MHSA regulations and attainment of program outcomes. RFA proposals will be required to contain an evaluation plan including attainable outcomes and associated measurement tools for the program services or project activities being proposed. Each RFA proposal will identify the MHSA Funding Component being supported as well as the MHSA COF Priority Area being addressed. These priority areas are determined by the MHSA Steering Committee with community input as part of the County’s MHSA planning process. Existing HCA contractors will be required to demonstrate compliance with all contracts over the last five years as well as having sufficient capacity and organizational stability during the same timeframe to apply for MHSA COF funding.
MHSA Funding Components:
- Community Services and Supports
- Prevention and Early Intervention
- Innovation (each RFA proposal would require additional approval by the MHSOAC)
- Workforce Education and Training
- Capital Facilities and Technological Needs
MHSA COF Priority Areas:
- Ethnic Disparities in Access to Care
- Early Childhood Mental Health
- Children’s Services
- Persons with Disabilities
- Arts and Stigma
- Laura’s Law/AOT, Serious and Persistent Mental Illness
- Comprehensive Case Management
- Supporting Private Conservators
- 12. System Navigation
- Linguistic Competency
- Community Outpatient
The LGAA will be contracted directly with the County ensuring continuity of governance by the Board of Supervisors. The LGAA will be required to hire qualified Contract Monitors and Program Officers to ensure compliance by grantees with MHSA regulations and reporting requirements as well as assist the County in preparing reporting to the State. A Request for Proposals (RFP) will be issued by HCA or the County Executive Office to select a pilot LGAA so that they can begin receiving MHSA RFA applications. Initial funding for the Innovation pilot LGAA will be $5,000,000 to test the viability of the approach as a long-term funding mechanism.
This version of the MHSA COF addresses regulatory and statutory issues raised by HCA BHS staff last year. It is being submitted for review to determine it’s viability in meeting MHSA Innovation requirements. Please consider the components open to adjustment if it is beneficial for advancing in the process.