Behavioral Health Services Act (BHSA)
The Mental Health Services Act (MHSA) was passed by California voters in 2004 and funded by a 1% income tax on personal income over $1 million per year. It was designed to expand and transform California’s behavioral health system to better serve individuals with, and at risk of, serious mental health issues, and their families. MHSA addressed a broad continuum of prevention, early intervention, and service needs and the necessary staff training, technology, and resources that make these services possible. In 2024, voters passed Proposition 1, which replaced the MHSA with the Behavioral Health Services Act (BHSA) and introduced several important changes for counties.
The MHSA was passed by California voters in 2004 and funded by a one percent income tax on personal income in excess of $1 million per year. It was designed to expand and transform California's behavioral health system to better serve individuals with, and at risk of, serious mental health issues, and their families. MHSA addressed a broad continuum of prevention, early intervention, and service needs and the necessary staff training, technology, and resources that make these services possible.
The Behavioral Health Services Act (BHSA) of 2024 replaces MHSA, effective July 1, 2026. It reforms behavioral health care funding to prioritize services for people with the most significant mental health needs while adding the treatment of substance use disorders (SUD), expanding housing interventions, and increasing the behavioral health workforce. BHSA guides counties to look at their whole behavioral health systems of care in their community planning process. It also improves oversight, transparency, and accountability at the state and local levels. Additionally, the Behavioral Health Services make care more fair and accessible by promoting equity and reducing gaps in services for people with behavioral health needs.
California Department of Health Care Services (DHCS) has given counties a Behavioral Health Services Act Policy Manual to serve as regulations. This document will be continually updated with changes implemented by DHCS.
BHSA was the first part of Proposition 1. The second part, the Behavioral Health Bond, authorizes $6.4 billion in bonds to finance behavioral health treatment beds, supportive housing, community sites, and funding for housing veterans with behavioral health needs.
Instead of creating separate plans, BHS will build one Integrated Plan to report on all BHS programming and expenditures for three-year periods, with updates at least annually. These Integrated Plans and the Annual Updates to these plans will be created with community input, including a 30-day posting and public comment period for draft plans and updates, and permanent posting of approved plans and updates on the BHS Reports & Workplans page. These plans and updates will be reviewed by our Sacramento County Board of Supervisors, by the California Department of Health Care Services (DHCS), and by the Behavioral Health Commission. BHSA further requires that DHCS shall establish requirements for the content of these plans/updates.
Using the expanded reporting requirements, BHS will define specific outcomes and report on progress. This will allow a view of what is working, opportunities to make adjustments, and will strengthen community trust by showing that public dollars are being used thoughtfully.
Sacramento County's BHSA Community Planning Process includes enhanced community engagement efforts to bring together a broad range of voices to provide input on mental health and substance use services, policies, program planning and implementation, budget allocation, and more.
Counties are required to engage with specific community partner groups as part of their Community Planning Process. Read the Stakeholder Involvement section in the Behavioral Health Services Act County Policy Manual for more details.
BHSA Funding Allocations
BHSA provides no new funding for behavioral health services. It shifts how counties can spend these dollars. Sacramento County BHS is prioritizing preserving current programs and services, where possible.
- 76% for Community Services & Supports (CSS)
- 19% for Prevention & Early Intervention (PEI)
- 5% for Innovation
Housing (30%):
- Children and families, youth, adults, and older adults living with SMI/SED and/or SUD who are experiencing or at risk of homelessness.
- Includes rental subsidies, operating subsidies, shared and family housing, capital, and the non-federal share for certain transitional rent.
- 50% is prioritized for housing interventions for the chronically homeless with behavioral health challenges.
Behavioral Health Services and Supports (BHSS) (35%):
- Outreach and engagement, workforce education and training, capital facilities, technological needs, and innovative pilots and projects.
- 51% of BHSS must be used for Early Intervention services to assist in the early signs of mental illness or substance misuse.
- 51% of BHSS Early Intervention services and supports must be for people 25 years and younger.
Full Service Partnership (FSP) (35%)
- Mental health, supportive services, and substance use disorder treatment services.
- Medication-Assisted Treatment (MAT).
- Community-defined evidence practices (CDEP).
- Assertive Community Treatment / Forensic Assertive Community Treatment, supported employment, & high fidelity wraparound are required.
- Outpatient behavioral health services, either clinic or field-based, are necessary for ongoing evaluation and stabilization of an enrolled individual.
- Ongoing engagement services are necessary to keep enrolled individuals on their treatment plan, including clinical and non-clinical services and services to support housing stability.
*Counties will have the flexibility to move up to 7% of funding from one category to another to allow counties to address their different local needs and priorities.
BHSA Priorities and Funding Allocation (printable one-page fact sheet)
Community Planning Process
BHSA requires counties to gather input from clients and partners across their entire continuum of care. Sacramento County BHS seeks input from recipients of Mental Health and/or Substance Use Prevention and Treatment services, as well as from family members and caretakers of recipients. We actively engage community partners to ensure diverse voices are heard. Your voice helps shape the future of Behavioral Health Services — because real change starts with community input.
Through the CPP, we are working to highlight strengths while also identifying unmet needs, service gaps, and opportunities for growth.
BHS has launched a multi-step approach to collect input for the first BHSA Integrated Plan, a three-year program and expenditure plan for the first three fiscal years of BHSA implementation (July 2026 – June 2029). In Phase 1, we advertised meetings and consulted with hundreds of clients and partners to gather their thoughts on the topic of Glows and Grows of BHS – what are positive practices and where is there room for improvement?
Phase 2 of the Community Planning Process took place in November 2025, when BHS reconnected with the community to validate Phase 1 input and collect additional feedback to guide the process.
The BHSA Community Planning Process Phase 1 Report contains a summary analysis of community feedback followed by all feedback received in Phase 1 of this community planning process. During Phase 2, we had public meetings with interested community members and presented BHSA Community Conversations Phase 2: Validation, containing this summary and our understanding of key points, as well as changes happening in the behavioral health system of care in Sacramento County as a result of the passage of BHSA. Additional feedback was requested. We are currently sorting and analyzing the additional feedback gathered; it will be shared here once this is done.
We appreciate your involvement in Phases 1 and 2 of the Behavioral Health Services Act (BHSA) Community Planning Process. You can receive updates regarding Behavioral Health Services and upcoming Behavioral Health Commission meetings by joining the BHS Distribution List.
Sacramento County has a new Behavioral Health Commission, with appointees from each district. Meetings are on the 3rd Thursday of each month and are open to the public.
Each Fiscal Year, BHS will be releasing an Integrated Plan and/or an Annual Update to report on the entire BHS Behavioral Health Services continuum of services and show our county’s plans for the future. These will be posted to the BHS Reports & Workplans page.