Sacramento Mayor asks county for $53 million for Whole Person Care Pilot Project focused on homelessness

Sacramento County and the City of Sacramento have recently struggled to coordinate on addressing homelessness, substance abuse, and mental health. The county decided not to participate in the Whole Person Care (WPC) pilot program, a four-year program to focus on supporting the homeless population, enhancing care coordination, and sharing patient data across providers for the Medi-Cal population.

Instead, the county approved a budget that included $6.2 million for initiatives approved by the Board of Supervisors to reduce homelessness and $1.6 million for additional staff for the Mental Health Intensive Outpatient Unit at the Main Jail.

An explanation from the county website outlines three main reasons why Sacramento County did not apply:

“WPC funding does not address the most critical needs of those who are homeless – health and behavioral health services and housing.

The County has focused its time and resources on programs that will offer more of what the homeless actually need.

The WPC would substantially risk County dollars that could be better spent on programs discussed above.”

The City of Sacramento did apply for the pilot project and will receive $64 million in funding to provide supportive services for 3,250 individuals over three years, increase homeless outreach capacity by two-three times, and reduce case management loads by 75 percent. Sacramento was the only city in California to participate; most of the other applications came from large counties.

Sacramento’s WPC pilot has four main components:

  1. Expanding existing outreach efforts
  2. Creating a comprehensive data system that identifies frequent users across multiple systems and tracks patient outcomes
  3. Building a robust care management system for WPC patients providing “whatever it takes” wraparound services including case management, transportation, behavioral health referrals and dental care referrals
  4. Creating a coordinated housing support system to help WPC patients experiencing homelessness access and maintain housing

However, the city and county need to work together in order to have success in the WPC pilot. Sacramento Mayor Darrell Steinberg wrote in an editorial:

“The county has stepped forward with its own sizable investments, approving $6.5 million in new services for the homeless. Rather than work on parallel tracks, we should consolidate resources so we are sharing data, integrating programs, amplifying impacts and weaving a true network of care.

When it comes to whole-person care, the city simply cannot succeed without the county’s help. And we have a clear and specific ask as we lay the groundwork for partnership: Giving these clients priority access to the county’s mental health and addiction services.

The county also will have a lead role in ensuring our region benefits from the “No Place Like Home” initiative. That’s legislation I sponsored in 2016 that leverages Mental Health Services Act funding to generate $2 billion statewide for permanent supportive housing for homeless people with mental illness. This year, the state is issuing planning grants, with project funding set to flow in 2018.

Taken together, we have unprecedented resources at our disposal, and an historic opportunity to work as a region, powering forward with shared vision and strategy. It’s time we commit to and achieve that goal.”

As part of the City of Sacramento’s WPC pilot, Sacramento County has committed to participate in city-county leadership meetings, provide technical assistance and training to the city WPC team, work to prevent duplication of city and county services in homeless programs, and explore data sharing with the city.

Mayor Steinberg has also asked Sacramento County to set aside approximately $53 million from its Mental Health Services Act Budget (MHSA) to work with the City of Sacramento on the WPC pilot by expanding current services.

“We have a once in a generation opportunity to fundamentally merge our resources,” said Mayor Steinberg to the Sacramento County Board of Supervisors. “That’s what we’re calling for. Fundamentally merge our resources and strategies and literally get thousands of people off the streets. So this is not about Whole Person Care. This is about taking the best of our resources, the best of your resources and working together to thousands of people off the street.”

MHSA funds are distributed to counties to fund county mental health programs. Funds must be spent within 3 years or the funds will be made available to other counties. The Governor signed a law (AB114) this summer requiring counties with unspent MHSA funds that were allocated before FY2017 and are now subject to reversion to expend those funds by 2020. Counties must provide a plan for how those funds will be spent by July 1, 2018.

Sacramento County currently has an estimated $98.4 million in MHSA funds. According to Toby Ewing, Executive Director of the Mental Health Services Oversight & Accountability Commission, Sacramento County currently has an estimated $11.4 million of MHSA funds subject to reversion.

There is approximately $275 million unspent funds subject to reversion across the state. Ewing also explained that the state had not been enforcing the reversion requirement in the past, but now intends to do so according to the changes made in AB114.

The Sacramento Board of Supervisors discussed the City of Sacramento’s request for $53 million in funding from the MHSA fund at a meeting on October 17th. County staff explained that the MHSA funds are not available for the WPC project because the funds are earmarked for future projects, including refinancing of existing permanent supporting housing beginning in 2021, which will cost an estimated $22 million.

“There seems to be an impression out there that we’ve squirreled away money or are hiding unspent funds that needs to be spent now, and I want to address that,” said Paul Lake, Sacramento County Deputy County Executive. “We have plans for all of our unspent balances and anticipated revenue. These plans have been carefully thought through and designed by the people who have to implement programs for this county, people who understand our local needs, our systems, and how to actually implement programs that have been designed at the capitol.”

During the meeting, Supervisor Patrick Kennedy read from a memo outlining some of the county’s plans for the funding No Place Like Home supportive services, which begins in FY 2021 and leaves $34.5 million out of $36.8 million unspent after 5 years. He asked Ewing, “Does that sound like a serious threat of reversion of those monies that are out there?”

“If I was sitting next to you as an advisor, I would be prepared to cover a shortfall when the state asks you to return that money,” replied Ewing.

Mayor Steinberg argued during his testimony that “It’s against the law to hold this kind of money” and the funds would be best spent now on the WPC pilot instead of waiting decades for future projects.

At the request of the County Board of Supervisors, the County Executive will conduct a workshop and prepare a detailed explanation of the MHSA funding as well as an action item for the Board’s consideration to determine how best to allocate that funding.