1. FUNDING MENTAL HEALTH SERVICES IN CALIFORNIA August 13, 2015

2. COMMUNITY MENTAL HEALTH SERVICES 1991 Realignment Mental Health Services Act (2004) 2011 Realignment Federal Financial Participation SAMHSA Grants

3. 1991 REALIGNMENT Bronzan-McCorquodale Act Institutions for Mental Disease State and Local Fund Allocations

4. BRONZAN-McCORQUODALE ACT As part of 1991 realignment, the Bronzan- McCorquodale Act realigned the existing Short-Doyle Community Mental Health Services Program. Counties are expected to provide mental health services to the identified target population, to the extent resources are available (W&I Code, Section 5600.3)

5. INSTITUTIONS FOR MENTAL HEALTH DISEASE As part of 1991 realignment, Part 5 realigned to counties the responsibility to pay for services provided in an IMD.

6. STATE AND LOCAL FUND ALLOCATIONS W&I Code, Section 17600 established the Local Revenue Fund with various accounts and subaccounts to fund 1991 realignment. Revenue received from a ½ cent sales tax and a portion of vehicle license fee is deposited into the Local Revenue Fund. Funds deposited into the Local Revenue Fund are allocated to the mental health account, social services account, and health account in each county’s local health and welfare trust fund pursuant to schedules established in statute.

7. THE LOCAL REVENUE FUND & 2011 REALIGNMENT Government Code, Section 30025 established the Local Revenue Fund 2011. Government Code, Section 30027.5 dedicates $93,379,252 per month to the Mental Health Account in the Local Revenue Fund beginning in 2012-13. The Mental Health Account in the Local Revenue Fund also receives the first 5% of funds in the Behavioral Health Services Growth Special Account.

8. CalWORKS MOE ACCOUNT 2011 Realignment also established the CalWORKS MOE Account within the Local Revenue Fund. The CalWORKS MOE Account receives funding from the Sales Tax Account and the vehicle license fee account that would have otherwise been deposited into the Mental Health Subaccount until a base is met.

9. MENTAL HEALTH SERVICES ACT Mental Health Services Fund Fund Allocations

10. MENTAL HEALTH SERVICES FUND Revenue collected from a 1% tax on income in excess of $1 million is deposited into the Mental Health Services Fund. Revenue deposited into the Mental Health Services Fund is distributed by the State Controller’s Office to counties on a monthly basis.

11. FUND ALLOCATIONS Eighty percent (80%) of the funds allocated are to be spent on the community services and supports (CSS) component. Twenty percent (20%) of the funds distributed are to be spent on the prevention and early intervention (PEI) component. Five percent (5%) of the funds allocated to the CSS and five percent (5%) of the funds allocated to PEI must be spent in the innovation component.

12. PRUDENT RESERVE Counties may dedicate funds allocated to the CSS component to a prudent reserve. The prudent reserve is intended to be used to maintain existing service levels when revenues decline.

13. 2011 REALIGNMENT Local Revenue Fund 2011 – Behavioral Health Subaccount – Behavioral Health Services Growth Special Account Distribution of Fund

14. LOCAL REVENUE FUND 2011 Government Code, Section 30025 established the Local Revenue Fund (LRF) 2011 Revenue collected from a ½ cent sales tax and some vehicle license fee revenue are deposited into the LRF 2011. Sales Tax Revenue is allocated among various accounts and subaccounts.

15. BEHAVIORAL HEALTH SUBACCOUNT A certain percentage of the sales tax revenue deposited into the Local Revenue Fund 2011 is allocated to the Behavioral Health Subaccount. Counties may use funds distributed from the Behavioral Health Subaccount to provide Medi- Cal Specialty Mental Health Services, Drug Medi- Cal Services, and other SUD service. The Governor’s Budget estimates that the Behavioral Health Subaccount will receive $1.193 Billion in FY 2015-16.

16. BEHAVIORAL HEALTH SERVICES GROWTH SPECIAL ACCOUNT Sales Tax Revenue deposited into the Local Revenue Fund that exceeds the amount deposited into the fund in the prior year is allocated to a growth account. A portion of those funds are allocated to the Behavioral Health Services Growth Special Account. The Governor’s Budget estimates that the Behavioral Health Services Growth Special Account will receive $140.9 Million in FY 2015-16.

17. FUND DISTRIBUTIONS Funds deposited into the Behavioral Health Subaccount are distributed to counties on a monthly basis pursuant to a schedule developed by Finance. Funds deposited into the Behavioral Health Services Growth Special Account are paid to counties in one distribution after September following the close of the fiscal year pursuant to a schedule developed by Finance.

18. FEDERAL FINANCIAL PARTICIPATION Interim payments Interim cost settlement Final Cost settlement

19. INTERIM PAYMENTS Counties submit claims to the Department through the Short-Doyle Medi-Cal claiming system to receive interim federal reimbursement for eligible services. Counties must also submit a signed paper claim, called a 1982 A, that certifies the county has incurred the expenditure being submitted for reimbursement.

20. INTERIM COST SETTLEMENT By December 31 following the close of each Fiscal Year, each county must submit a cost report for each of its legal entities. The Department uses these cost reports to determine how much it actually cost to provide the services for which the county received an interim payment. The Department compares the interim payments made to the actual cost to identify over- and under-payments.

21. FINAL SETTLEMENT The Audits and Investigations (A&I) division has three years from the date the cost report was last amended to audit the cost report. Counties that do not agree with the results of the audit may appeal. Once the audit is completed and all appeals have been resolved, the cost settlement is considered final.

22. SAMHSA GRANTS Mental Health Block Grant Projects for Assistance in Transition from Homelessness (PATH)

23. MENTAL HEALTH BLOCK GRANT The majority of funds are allocated among counties pursuant to a population based formula. A limited amount of funding is set aside: – Children’s system of care programs – Mental health and substance use disorder dual diagnosis programs – First episode psychosis programs Counties on paid on a quarterly basis based upon expenditure reports.

24. PATH Funds are distributed among 41 counties pursuant to a population based allocation formula. Counties are paid on a quarterly basis based upon expenditure reports.